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small rounded wartlike protuberance on a plant (同)tubercle
(mineralogy) a small rounded lump of mineral substance (usually harder than the surrounding rock or sediment)
a small node
a person suffering with rheumatism

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(鉱石などの)小塊 / (植物の茎・根,動物の組織にできる)小結節,こぶ
リューマチの / リューマチにかがった / リューマチ患者

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出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2016/06/13 07:14:16」(JST)

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A rheumatoid nodule is a local swelling or tissue lump, usually rather firm to touch, like an unripe fruit, which occurs almost exclusively in association with rheumatoid arthritis. Very rarely rheumatoid nodules occur as rheumatoid nodulosis in the absence of arthritis. They are usually subcutaneous especially over bony prominences such as the olecranon (tip of the elbow) or the interphalangeal joints (finger knuckles). Less commonly they occur in the lining of the lung and other internal organs. The occurrence of nodules in the lung of miners exposed to silica dust was known as Caplan's syndrome. Nodules vary in size from that of a lentil or pea to that of a mandarin orange. Quite often they are associated with synovial pockets or bursae. About 5% of rheumatoid arthritis patients have such nodules within two years of disease onset, and the cumulative prevalence is about 25%. In the great majority of cases nodules are not painful or disabling in any way, being more of an unsightly nuisance, but in some cases they can be painful, especially if the overlying skin breaks down.^[1] Rarely, the nodules occur at diverse sites on body (e.g. upper eyelid, distal region of the soles of the feet, vulva and internally in the gallbladder, lung, heart valves, larynx, and spine).^[2]

Pathology

Histological examination of nodules shows that they consist of a shell of fibrous tissue surrounding a center of fibrinoid necrosis. Pea-sized nodules have one centre. Larger nodules tend to be multilocular, with many separate shells or with connections between the necrotic centres. Individual necrotic centres may contain a cleft or several centres of necrosis may all open on to a large bursal pocket containing synovial fluid.

The boundary between the necrotic centre and the outer fibrous shell is made up of the characteristic feature of the nodule, which is known as a cellular palisade. The palisade is a densely packed layer of macrophages and fibroblasts which tend to be arranged radially, like the seeds of a kiwifruit or fig. Further out into the fibrous shell there is a zone that contains T cells and plasma cells in association with blood vessels.

The overall histological picture is essentially identical to that of rheumatoid synovitis with the main differences being that the palisade replaces the synovial intima (they may blend imperceptibly in bursae) and an almost total absence of B cells.

Histopathology images

Treatment

Treatment of rheumatoid nodules is rarely a priority for people with rheumatoid arthritis. However, surgical removal is often successful, even if there is a tendency for nodules to regrow. Of the drug therapies commonly used in rheumatoid arthritis, methotrexate has the disadvantage of tending to make nodules worse. TNF inhibitors do not have a very reliable effect on nodules. B cell depletion with rituximab often leads to disappearance of nodules but this is not guaranteed.

References

^ Carmona L, González-Alvaro I, Balsa A, Angel Belmonte M, Tena X, Sanmartí R (September 2003). "Rheumatoid arthritis in Spain: occurrence of extra-articular manifestations and estimates of disease severity". Ann. Rheum. Dis. 62 (9): 897–900. doi:10.1136/ard.62.9.897. PMC 1754657. PMID 12922967. .
^ Upile T, Jerjes W, Sipaul F, Singh S, Hopper C, Wright A, Sandison A (2007). "Rheumatoid nodule of the thyrohyoid membrane: a case report". J Med Case Rep 1: 123. doi:10.1186/1752-1947-1-123. PMC 2174496. PMID 17974016.

UpToDate Contents

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1. リウマチ結節 rheumatoid nodules
2. リウマチ性心疾患の自然史、スクリーニング、および管理 natural history screening and management of rheumatic heart disease
3. 孤発性肺結節性病変の診断的評価および管理 diagnostic evaluation and management of the solitary pulmonary nodule
4. ケラトアカントーマ：疫学、危険因子、および診断 keratoacanthoma epidemiology risk factors and diagnosis
5. 眼性酒さ ocular rosacea

English Journal

The type 2 cannabinoid receptor regulates bone mass and ovariectomy-induced bone loss by affecting osteoblast differentiation and bone formation.

Sophocleous A, Landao-Bassonga E, Van't Hof RJ, Idris AI, Ralston SH.SourceRheumatic Diseases Unit, Molecular Medicine Centre, Institute of Genetics and Molecular Medicine, University of Edinburgh, Western General Hospital, Edinburgh EH4 2XU, UK.
Endocrinology.Endocrinology.2011 Jun;152(6):2141-9. Epub 2011 Mar 29.
The type 2 cannabinoid receptor (CB2) has been reported to regulate bone mass and bone turnover but the mechanisms responsible are incompletely understood. In this study we investigated the role that the CB2 pathway plays in bone metabolism using a combination of genetic and pharmacological approach
PMID 21447627

An animal model of chronic rheumatic valvulitis induced by formalin-killed streptococci.

Xie X, Zhou H, Huang J, Huang H, Feng Z, Mei K, Yu B, Su Z, Gu J.SourceDepartment of Cardiology, The Third Affiliated Hospital of Sun Yat-sen University, 510630, Guangzhou, People's Republic of China.
Rheumatology international.Rheumatol Int.2010 Nov;30(12):1621-5. Epub 2009 Dec 12.
Rheumatic heart disease is the most severe complication of rheumatic fever. Till date, very few successful animal models of rheumatic valvular disease have been reported. This study aimed at developing a suitable animal model of chronic rheumatic valvulitis for further investigation and prevention o
PMID 20012632

Japanese Journal

巨大リウマチ結節により完全房室ブロックと高度僧帽弁閉鎖不全を同時に発症した1例

荒川健太郎,山澤美緒子,森田有紀子,小林泉,堀口順子,上村大輔,渋江竜馬,三富弘之,姫野秀朗,根本豊治,當間重人
Journal of cardiology 46(2), 77-83, 2005-08-15
NAID 10016650981

リウマチ性心疾患 : 再考(老研究者の覚え書)

岡田了三
群馬パース学園短期大学紀要 5(1), 185-205, 2003-03-31
… During 1957 to 1963, the author had experienced many autopsy cases of rheumatic heart disease. … The first case was a 15 year-old girl who suffered of rheumatic fever before 3 years and combined valvular disease before 2 years to her dearh due to congestive heart failure. … Pathological diagnosis was rheumatic pancarditis consisted of mitral, aortic and tricuspid valvulitis with functional regurgitation of the blood flow, acute myocarditis with Aschoff nodules and fresh pericarditis. …
NAID 110004708547

「Aschoff body」

Rheumatoid nodule
	Micrograph of a rheumatoid nodule, showing the characteristic palisading granuloma with a core consisting of necrotic collagen and fibrin. H&E stain.
Classification and external resources
ICD-10	M06.3
MeSH	D012218
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