Rheumatoid nodulosis. A relatively benign rheumatoid variant

Subcutaneous nodules and rheumatoid factor (RF) are criteria used to diagnose rheumatoid disease. Their presence correlates with disease severity and poorer prognosis. They have been reported, however, in patients with little arthritis and no systemic disease. We studied four such patients, in whom (1) RF was present in high titer; (2) nodules were often extensive (nodulosis) and involved elbows, hands, and feet, with a predilection for tendons; and (3) roentgenograms showed large, subchondral bone cysts without cortical erosion of correlation with nodule location. The conditions of three of these patients had been previously misdiagnosed as gout or xanthoma. Our findings were similar to those in seven other patients described in earlier reports. We suggest that nodulosis, bone cysts, and elevated RF with little active arthritis constitute a relatively benign variant of rheumatoid disease.