Sunday, May 15, 2011

The Queen of Nodules

I am becoming the queen of rheumatoid arthritis nodules.  I discovered a new one the other day on my finger.  Part of my freak out procedure is to have everyone near me feel it to verify that I am not making it up in my own head.  Sophia was the lucky one this time since we were in the car together. 
Me:  Feel this.
Sophia:  Oooohhhh...what is that?
Me:  Another nodule.
Sophia:  (No need to explain nodules to this 13 year old.  She completely understands the word). Don't worry.  You still look pretty.
Me:  Yeah, people will say, "From far away she is pretty, but once you touch her, she is all gross and bumpy."
Sophia:  laughs.

At one time in my life, these small changes in my body created a huge fear.  Now, I have a momentary freakout and then I move on remembering that even though a new nodule has become part of my body, my body is also doing some rather amazing things.  Instead of thinking of them as deformities to my body, I think of them as trophies.  They represent the hard work I have put into healing and stay with me as a reminder of what can be and what has been, but not necessarily of what is right now. 

According to WebMD:
  • Rheumatoid nodules usually occur in patients with severe RA. Nearly all RA patients with nodules test positive for rheumatoid factor." (Yep, that's me.)
  • Rheumatoid factor is positive in 70% to 80% of people with RA. Studies show that when RA is linked with a positive rheumatoid factor test, it may indicate more aggressive disease. (Yep, that's me.)
  • Other factors may increase the chance of RA nodules. One study found that cigarette smoking increases nodules in patients with RA. (Nope, not me.) Methotrexate, a commonly used RA drug, has also been linked to increased development of rheumatoid nodules. (Yep, that is me.) Sometimes disease-modifying antirheumatic drugs (DMARDs) can reduce the size of RA nodules. But patients who take methotrexate may develop an increase in size and number of nodules. If nodules are thought to be a result of methotrexate treatment, a change in medication regimen may help; however, this decision must be carefully made on an individual basis.
Since I have developed several nodules throughout my body the last few years, my rheumatologist has mentioned that methotrexate can be a contributor to the nodules and wants to watch them.  Although I just found this newest module the other day, I planned to bring up reducing my methotrexate last week at my appointment, but I forgot.  I will remember it for next time.  Since my lab work has looked fantastic the last few times and I feel well, I don't think she will have a problem with it. (Oh, we did a new chest x-ray too because she had concerns of nodules developing on the lungs but the x-ray came out great this time!)  We did talk about reducing medications once I felt better when I agreed to go back on them.  I hope she agrees with me, but whether she does or not, the decision is always up to me.  It is my body after all, nodules and all!


  1. Thrilled to hear about the chest xray being clear. Please keep in mind though that regular x-rays do not always pick up interstitial lung disease in RA patients, so may want to schedule a full set of pulmonary function tests to have as a baseline. Consider an HRCT, but only if there is question after a full set of PFT's that should include spirometry, lung volumes and diffusion.

    I had nodules early on, and yes some increased after first starting on methotrexate. I was off of it for a few years and went back on, with no nodules this time. The previous ones went away after some years. I've never seen an article showing any connection, but this time I am taking 1 MG of prescription grade folic acid, whereas before I was just taking over-the-counter folic acid (400 mcg). Perhaps that made a difference?

  2. Sorry to hear about the new nodule but it seems you're taking it in your stride. Your daughter's very right to say you still look pretty and no one will notice the nodule but you.

    I'm the same about the weird little things that pop up all the time cos of the RA. I have a wee freak out, obsess over the area for about a day and then move on. :)

  3. Hi!
    I was wondering if you would be interested in having a piece of your work (a blog post perhaps) published in a zine?
    I’m doing it as a project for college and it’s an attempt on my behalf to collaborate short stories from others who have RA/JRA. I hope to strengthen the community by developing this zine, but I need people to contribute, so that I have content to publish!
    If you are interested, please visit my blog and look under the post labelled “Attention all Arthritis bloggers..opportunity to have your words published in a zine.”

    Hope to hear from you soon,