To Dee: RA pannus & nodules

 Dear Dee,

 

I hope the following helps you a bit and maybe some other folks who might be wondering the same thing as well.  The info I provide is strictly based on my medical experience and reference materials...so for any serious clarification, your doc might have more specific guidance geared towards YOUR specific case!

 

Chronic rheumatoid arthritis patients often get rheumatoid pannus (nodules).

These pannus are basically inflammed synovial (synovial=joint fluid) granulation tissue. These rheumatoid nodules are firm, under the skin masses typically found in areas like the extension of your forearm, elbows, and over areas where there is pressure.  

 

If you were ever to look @ one in a biopsie...it's kinda looks like a tapioca pudding bead!!!  Just thought that would be a good visual and explanation!  hee hee.

 

How do they form?

 

We know that with RA, our joints and their fluids are inflammed.  In a joint, there is a synovial membrane (a joint capsule) which is responsible for producing the fluid that lubricates our joints.  This membrane hypertrophies (gets real thick) over time due to all of this inflammation.

So now we have a very thick "helmut" thingy on the joint of a systemic RA pt...with all the inflammation going on, the blood supply isn't so great.  Some areas of this thick "helmut" get blocked off from O2 and blood, and then they kinda "scab" up, or a process called granulation. { I.E.  Say for instance you're making a pot roast...after cooking for a long time, you get these burnt crusties that fall off and they make great gravy!  Kinda the same process going on! }

Now these pannus gradually float away or extend from the thick joint membrane and we can then see and feel them under the skins surface. 

 

WHERE THE HECK DO I GET MY ANALOGIES FROM?  I HAVE NO IDEA!!  LOL   

RA pannus can also form in other places like the eye (cornea).

They may form in places like the heart, lungs, and spleen too.

Some nodules can be very thick, opaque, painful.  They are called Crassus.  They hurt because they are getting a lot of blood.  (kinda like how a new bruise or cut hurts real bad...all the blood is there making it painful).

 

Pannus can also be in areas that are very very dry, in excema, rosacea for example.  This is called Siccus pannus and the nodule is not vascularized or it's poorly vascularized.

 

  So what do we do now??     We've got these annoying painful balls under our skin.

We treat them with our RA meds; pain meds if they are painful; topical anesthetics; application of heat or ice; paraffin dips; removal if absolutely necessary.

 

Has your primary doc seen them??  If it is very bothersome to you...be persistant.  Keep an eye on them to watch for anything abnormal...like growth, change in color, etc...to be sure you know that that's what you are dealing with and not anything like calcium deposits or fatty tumors or other stuff. 

In closing...these little buggers are a good way in diagnosing RA!  It is a good tell tale sign...just to leave ya on a positive note.

Well, I hope this comes in handy & puts your mind at ease.  Many many people have  them and it's part of RA.

Let me know if I can try to find out anything more.

I wish you well & take good care!

Sincerely,

Erin VIEW IMAGE 

Post Edited (erin kachmar) : 9/8/2005 2:08:20 PM (GMT-6)

hey dee,
your hands have some of the most intricate and numerous joints...so they would be a common spot for the RA nodules. especially since you say they look like the knarled hands like we see in the text book.
i know you've probably been to a slew of docs....what about a Joint Disease hospital?
since they come and go...it sounds like it acts like it goes into remissions and exacerbations.
did anyone ever want to biopsie them??
i'm going to look at some pictures of dermatological disorders that resemble those pin head bumps and see what names they are given.
just a question...do you get them on your face? or anywhere else on your body?
hhmmm??? i definitely see why this is tricky.
take good care
erin

Dee, Are the spots, browny beige bubbles with pus in some of them? If they are they could be palmar pustular psoriasis. That is what I get. I had it very severe on my foot and one hand. Then I went for PUVA treatment for two years and they finally went away. Now I only get them on my hands occasionally if I am stressed. Mine do not last long either. I can ususally pick them off. I did manage to get one biopsied by getting a dermy who would let me just go to her office when they showed up. If you go to google and type this in, press search only Canada, then go to images, you can see some pics. Hope this helps and was not just a nusiance. I could be way off, it is just that mine were that size and came and went.
Judy

effie,
i was thinking the same thing too!
do yours come only a few times a year??
i give dermatologists a lot of credit...they're "LOOKERS", ya know what i mean? one of the best diagnostic tools is observation....and many docs fail to look closely at things.
it's amazing at what diseases can be diagnosed by looking at the skin, nails and hair.
{{{{{{{{{ hugs }}}}}}}}}}}}}}}}
erin

Dear Erin,
My goodness you do sound better. My palmar pustular psoriasis began shortly after my first husband died. Coincidentally that year I was also working in a new school in a classroom for students with serious behavioural and learning issues. I discovered that the paint that was peeling off the walls was lead based. It was a really old school. When I first started I had a rash and my family doctor wrote a note demanding that the school board have the paint flakes tested. They took the note seriously and the paint was tested. It did contain significant amounts of lead. My doctors concern was lead dust, so she demanded that all areas that were painted with lead be stripped, repainted and certain areas encapsulated.
Anyway the rash was initially treated as excema. Then I noticed that these little pustules would form and eventually turn to a brown dot, eventually the brown dot would scab and fall off. The condition got worse and worse. Finally I did the PUVA treatment every other day for two years. Then I went into a complete remission for several years. about two years ago my sister and I exchanged some harsh words, and then within a few days my hand started getting pustuals again. I treated it immediately with a steroid based cream. Now I get the brown spots off and on. The doctors say it is psoriasis, but know one knows the cause. Stress seems to aggrivate it but the dermatologist and rheumatologist say that stress is not the cause. The pus apparently is sterile. I do not understand that. Surprisingly when I am on certain antibiotics the spots reduce significantly. The dermatologist says that this is normal. The family doctor says that since the pus is sterile antibiotics should have no effect on it. Never know who to listen to???? I think Erin knows more than any of them!!!!!
One day Erin you will be a famous diagnostic doctor. I see it now. Your name will be on the doc's stitches magazine and in the Journal of Medicine.

Flopsie I agree she does sound better, hope it is contagious!!!

Hi again all,

I'm late in replying here (daughter's first year in school and we are starting to get sick already - a cold this time... LOL) so I have several different responses to each of you. Here goes. First...to effie, thank you so much for sharing "bump" stories LOL. My bumps are different than the ones you are experiencing though. Mine are not on the surface...they form under the skin. And you can only feel them, you can't see them. Here is a description given by my husband....little balls of hard fat. Whatever that means.  Your bumps don't sound seem any more appealing than mine though. I doubt any bumps do  LOL. To flopsie and erin - erin was not doing well recently???? I wasnt aware...but no...I would never have been able to tell...YOu sound so happy and "on the ball". . And please...share the honey story  LOL.

To erin...since you like solving medical problems and playing detective...makes me wonder if you were born under the sign of Scorpio...they are famous for those very qualities. I have no doubts that you will be going very far in your field. Best of luck to you. And thank you so much again for taking an interest in my "mystery bumps".

AND TO ANYONE READING THIS

Please, please share your knowledge if these bumps of mine sound familiar to you. The more people this baffles...the more I want to know what they are  LOL..