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Arthritis and Rheumatism

Little lumps on lower arms

07/12/2007

Question:

I have a little lump under my skin, on both lower arms, about 3 inches from my elbows. The lumps are the size of a grain of rice, and are movable. They feel like hard gelatin, and get bigger and smaller. After I squeezed one, it started hurting later, but the pain went away the next day. Could these be rheumatoid nodules. Do they appear with sero-negative arthritis? I have had them for about two years.

Answer:

Rheumatoid nodules are subcutaneous (under the skin) nodules that often occur over areas of pressure in individuals with RA. A typical location is just below the elbow on the side of the forearm that aligns with the small finger. The nodules may be moveable or fixed to underlying structures. Rheumatoid nodules occur in approximately 20% of individuals with RA, most often, but not exclusively, in patients with an elevated Rheumatoid factor. The nodules have a very typical appearance on microscopic examination/biopsy. There is also an entity of Rheumatoid nodulosis without RA.

Not all nodules on the forearm are Rheumatoid nodules. Other possibilities include, but are not limited to, lipomas (fat deposits) or sebaceous cysts.

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Response by:

Raymond  Hong, MD, MBA, FACR Raymond Hong, MD, MBA, FACR
Formerly, Assistant Professor of Medicine
School of Medicine
Case Western Reserve University