Il nodulo reumatoide

Rheumatoid nodules are superficial lesions, classified as a granulomatosis inflammation, commonly found in the deep subcutaneous tissue; they may involve deeper connective tissue structures, vary greatly in size, have hard-elastic consistence and are usually asymptomatic. The nodules are more likely to appear in areas subjected to repeated microtrauma such as the extensor surface of the arms and elbows. Presently, the most valued pathogenetic hypothesis about rheumatoid nodules etiology is connected with the interaction between mechanical and immunological factors (repeated vascular microtrauma and rheumatoid factor positivity). Repeated local injuries may lead to recurrent small hemorrhages; in the seropositive individual, this may result in the local collection of serus fluid containing immune complexes able to activate the chronic flogistic reaction. Patients with rheumatoid nodules form a wide spectrum of clinical entities, ranging from those with severe seropositive rheumatoid arthritis (most usually), to patients without any signs, symptoms, or laboratory abnormalities other than the nodules (clinical entity known as 'rheumatoid nodulosis'). This spectrum may be classified into five groups; the first three groups comprise conditions found in adults, whereas the latter two comprise conditions occurring in children. Till today there is not a specific therapy able to give a rheumatoid nodules remission; among the different drugs commonly used in the treatment of rheumatoid arthritis, the only ones with positive effects on nodules development are D-penicillamine and gold salts. Accelerated nodulosis is frequently encountered during methotrexate treatment for advanced rheumatoid arthritis. Surgical excision of nodules is often followed by recurrence of the granulation tissue in exactly the same location.