Find out about these little bumps related to rheumatoid arthritis.

Fast Facts

Some people with rheumatoid arthritis will develop nodules under the skin, which are visible on the elbows, hands, and feet.  

Most nodules don't cause problems, so they usually don't need to be treated.

If nodules are problematic because they limit the range of motion in a joint, make walking painful, press on nerves, or cause other issues, treatments are available.

Aside from problems with your joints, a common symptom of rheumatoid arthritis you may notice is the growth of rheumatoid nodules. About 20 to 25 percent of people with rheumatoid arthritis will develop nodules under the skin, which are frequently visible on the elbows, hands, and feet and range in size from a pea to a mothball. They're more common in men than in women, and Caucasians are more likely than other ethnicities to develop them.

The occurrence of nodules is largely limited to people who test positive for rheumatoid factor or an antibody known as anti-cyclic citrullinated peptide (ACPA); they're relatively rare in those who test negative for it. (Rheumatoid factor and ACPA are diagnostic markers of rheumatoid arthritis.)

"Many times nodules are just noticeable, but they may cause discomfort depending on their location and size," says E. William St. Clair, MD, professor of medicine and chief of the division of rheumatology and immunology at the Duke University School of Medicine in Durham, North Carolina. (For example, they may be painful when located on the bottom of the feet). However, he says, nodules tend to be found in people with more severe rheumatoid arthritis.

Coping With Rheumatoid Nodules

Medical researchers have spent a lot of time studying these little knots, which are made of inflammatory tissue. Although most of the focus is given to nodules in the skin, they can also show up in other places around the body, including the lungs, heart, and tendons. If you're concerned that you have nodules related to your rheumatoid arthritis, here are some ways to identify them:

• They usually show up after you've had rheumatoid arthritis for some time. But you can also get them before you have joint problems.
• They commonly show up on body parts that often feel pressure, such as your elbows, fingers, back, heels, and the back of your head. They may begin growing after you've had a minor trauma in a spot.
• They may feel firm and rubbery, or soft and squishy. When you touch them, they may feel stuck in one place, or they may move around.
• They're flesh-colored and can range greatly in size, from less than four millimeters (less than the width of a pencil eraser) to more than a half-inch.

Treating Rheumatoid Nodules

Since nodules don't generally cause any problems, they usually don't need to be treated. In fact, some experts caution against surgical removal of the nodules, as they may often return or even become infected. But if they're on your feet, your shoes can rub them, causing irritation. Nodules on the bottom of your feet may also make walking painful, says Dr. St. Clair. In addition, the skin over the nodules may break down, which can lead to an open sore or infection. Nodules may also press on nerves or limit the range of motion in a joint, depending on where they form.

It’s possible that the disease-modifying antirheumatic drugs (DMARDs) taken for rheumatoid arthritis will help shrink nodules. If you have a large nodule, however, your doctor can inject it with a steroid medication to shrink it. Surgery may also be required if the nodule is causing such problems as nerve pain, an open sore, or range-of-motion issues.

Additional reporting by Cheryl Alkon.