Skin inflammatory (nontumor)
Dermal granulomatous and necrobiotic reaction patterns
Rheumatoid / rheumatic nodules

Author: Mowafak Hamodat, M.D., MB.CH.B, MSc.

Revised: 16 October 2018, last major update August 2011

Copyright: (c) 2002-2018,, Inc.

PubMed Search: Rheumatoid / rheumatic nodules "loattrfree full text"[sb]

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Cite this page: Hamodat, M. Rheumatoid / rheumatic nodules. website. Accessed January 22nd, 2019.
Definition / general
  • Associated with adult and juvenile rheumatoid arthritis and rheumatic fever, in extensor elbow and other joints
  • Usually subcutis
  • Large, firm, asymptomatic, dome-shaped masses; may be painful
  • Subcutaneous lesions develop at sites of trauma or at pressure points
  • May involve abdominal wall and heart
Clinical images

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Rheumatoid nodules of fingers

Microscopic (histologic) description
  • Typically in subcutaneous fat or soft tissue, although may extend to deep reticular dermis
  • Note that granuloma annulare and necrobiosis lipodica have more superficial locations
  • Fibrin deposition and necrobiosis is often seen in center of nodule surrounded by well developed palisading of histiocytes, vascular granulation tissue, lymphocytes, plasma cells, eosinophils, variable giant cells, fibrosis in older lesions, occasional giant cells
  • No asteroid inclusions
  • Occasionally leukocytoclastic vasculitis
Microscopic (histologic) images

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Contributed by Hillary Rose Elwood, M.D.

Subcutaneous necrobiosis and fibrinoid degeneration with palisaded histiocytic inflammation

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Rheumatoid nodule-subcutis

Differential diagnosis
  • Deep granuloma annulare, which tends to have more mucin deposition and less fibrin
  • Epitheloid sarcoma