title: Rheumatoid nodulosis. Two cases with destructive polyarthritis after 20 years.
abstract: The term "rheumatoid nodulosis" was coined by Ginsberg in 1975 to designate a rare and distinctive form of rheumatoid disease. Anecdotal case reports suggest a benign nondestructive course, although prolonged follow-up data are usually unavailable. We describe two cases of typical rheumatoid nodulosis with follow-ups exceeding 25 years. Onset occurred at 14 and 22 years of age, respectively. Both patients presented with palindromic rheumatism, positive tests for rheumatoid factors, negative tests for other biological markers, and normal radiographs. Multiple subcutaneous nodules developed after 4 and 6 years with palindromic flares, respectively. Functional impairments and disfigurement required several surgical procedures to remove nodules. Histology was typical for rheumatoid nodules. Neither patient responded to disease-modifying anti-rheumatic drugs (gold, antimalarials, and D-penicillamine). Treatment consisted of nonsteroidal anti-inflammatory drugs combined with prednisone as needed. After 20 and 22 years of follow-up, respectively, both patients had typical rheumatoid arthritis with deformities and radiological joint destruction. In conclusion, these two cases establish that rheumatoid nodulosis can occur as a presentation of rheumatoid arthritis with a potential for severe joint damage after many years.
authors.affiliation: Rheumatology Department, Bichat Teaching Hospital, 46, rue Henri Huchard, 75018 Paris, France. froux@hopital-saint-joseph.org
authors.forename: Fabienne
authors.initials: F
authors.lastname: Roux
authors.forename: Marie-José
authors.initials: MJ
authors.lastname: Wattiaux
authors.forename: Gilles
authors.initials: G
authors.lastname: Hayem
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Palazzo
authors.forename: Marcel-Francis
authors.initials: MF
authors.lastname: Kahn
authors.forename: Olivier
authors.initials: O
authors.lastname: Meyer
mesh_terms: D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use; D001168:Arthritis / Q000000981:diagnostic imaging / Q000473:pathology* / Q000628:therapy; D004359:Drug Therapy, Combination; D005260:Female; D005384:Finger Joint / Q000473:pathology / Q000503:physiopathology; D005500:Follow-Up Studies; D005938:Glucocorticoids / Q000627:therapeutic use; D006801:Humans; D008875:Middle Aged; D011241:Prednisone / Q000627:therapeutic use; D011859:Radiography; D012218:Rheumatoid Nodule / Q000473:pathology* / Q000601:surgery; D016896:Treatment Outcome
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D005938:Glucocorticoids; D011241:Prednisone