rheumatoid nodule

WordNet

1. small rounded wartlike protuberance on a plant (同)tubercle
2. (mineralogy) a small rounded lump of mineral substance (usually harder than the surrounding rock or sediment)
3. a small node

PrepTutorEJDIC

1. (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
2. リューマチ[性]の

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出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2014/08/16 01:27:01」(JST)

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

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 tip of the elbow or olecranon or over the 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 2 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. Rarely, the nodules occur at diverse sites on body (e.g. upper eyelid, distal region of soles, vulva and internally in the gallbladder, lung, heart valves, larynx and spine).

Diagnosis

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 kiwi fruit or fig. Further out into the fibrous shell there is a zone that contains T lymphocytes 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 lymphocytes.

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

UpToDate Contents

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• 1. リウマチ結節 rheumatoid nodules
• 2. 関節リウマチの全身および非関節症状の概要 overview of the systemic and nonarticular manifestations of rheumatoid arthritis
• 3. 関節リウマチ関連肺疾患の概要 overview of lung disease associated with rheumatoid arthritis
• 4. 関節リウマチの神経学的症状 neurologic manifestations of rheumatoid arthritis
• 5. ガングリオンと結節 ganglia and nodules

English Journal

• Combining anti-cyclic citrullinated peptide with the American College of Rheumatology 1987 criteria failed to improve early rheumatoid arthritis diagnosis in the community-based very early arthritis cohort.

• Le Loet X, Strotz V, Lequerre T, Boumier P, Pouplin S, Mejjad O, Daragon A, Jouen F, Vittecoq O, Fardellone P, Menard JF.SourceRheumatology Department, CHU-Hopitaux de Rouen, 76031 Rouen Cedex, France. xavier.le-loet@chu-rouen.fr.
• Rheumatology (Oxford, England).Rheumatology (Oxford).2011 Oct;50(10):1901-7. Epub 2011 Jul 12.
• Objectives. To test the performances of combining anti-CCP second generation (CCP2) with ACR 1987 classification criteria and to diagnose early RA in a community-based very early arthritis (VErA) patient cohort. Methods. The VErA cohort comprised 310 patients (median age 52 years; 68.1% women; media
• PMID 21750000

Japanese Journal

• 局所麻酔下胸腔鏡にて診断に至ったリウマチ性胸膜炎の1例

• 石井 聡,竹田 雄一郎,平野 聡,中道 真仁,米嶋 康臣,仲 剛,飯倉 元保,伊藤 秀幸,小林 信之,工藤 宏一郎
• 気管支学 : 日本気管支研究会雑誌 33(2), 99-103, 2011-03-25
• … 関節リウマチであることは確実であった.しかし,胸水に関してはADA高値ということもあり結核性胸膜炎との鑑別が必要であったため,局所麻酔下胸腔鏡を施行した.胸腔内は全体的に壁側胸膜が顆粒状に肥厚しており,同部位を生検した.病理結果よりRheumatoid noduleを認め,リウマチ性胸膜炎と診断された.結論.今回,局所麻酔下胸腔鏡検査を行い,リウマチ性胸膜炎の診断に至った1例を経験したので報告する. …
• NAID 110008609500

Related Links

• Rheumatoid nodule - Wikipedia, the free encyclopedia

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 ...

Related Pictures

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★リンクテーブル★

リンク元	「リウマトイド結節」
関連記事	「rheumatoid」「nodule」

「リウマトイド結節」

　　[★]

英

rheumatoid nodule

同

rheumatoid nodule

「rheumatoid」

　　[★]

• adj.

• リウマチ様の、リウマチの、リウマトイド

関

rheumatic、rheumatism

　

「nodule」

　　[★]

• n.

• 小さいこぶ、小塊。(解剖)小結節/結節。(植物)根粒。(鉱物)団塊