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Rheumatoid nodulosis. Two cases with destructive polyarthritis after 20 years.
Fabienne Roux1, Marie-José Wattiaux, Gilles Hayem
1Rheumatology Department, Bichat Teaching Hospital, 46, rue Henri Huchard, 75018 Paris, France. froux@hopital-saint-joseph.org
Joint Bone Spine
|December 27, 2005
Summary
Rheumatoid nodulosis, initially thought benign, can progress to severe rheumatoid arthritis with joint destruction over decades. Long-term studies reveal this rare condition may lead to significant functional impairment and disfigurement.
Area of Science:
- Rheumatology
- Clinical Medicine
- Pathology
Background:
- Rheumatoid nodulosis is a rare variant of rheumatoid disease, with limited long-term data on its clinical course.
- Previous reports suggested a benign, non-destructive progression, but lacked extended follow-up.
- This study investigates two cases of rheumatoid nodulosis with over 25 years of follow-up.
Observation:
- Two patients presented with palindromic rheumatism, positive rheumatoid factor, and normal initial radiographs.
- Subcutaneous nodules developed years after disease onset, causing functional impairment and disfigurement.
- Histological examination confirmed typical rheumatoid nodules.
Findings:
- Neither patient responded to disease-modifying anti-rheumatic drugs; management involved NSAIDs and prednisone.
- Both patients developed typical rheumatoid arthritis with significant joint deformities and radiological destruction after 20-22 years.
- Rheumatoid nodulosis can represent an early presentation of rheumatoid arthritis with long-term destructive potential.
Implications:
- Rheumatoid nodulosis should be recognized as a potential precursor to severe, deforming rheumatoid arthritis.
- Extended monitoring is crucial for patients with rheumatoid nodulosis to manage potential joint damage.
- This highlights the importance of long-term follow-up in understanding rare rheumatic disease variants.