To Dee: RA pannus & nodules

New Topic Post Reply Printable Version
[ << Previous Thread | Next Thread >> ]

erin.K
Veteran Member


Date Joined Mar 2005
Total Posts : 3148
   Posted 9/8/2005 1:02 PM (GMT -7)   
cool  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! cool
 
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. tongue
 
How do they form? eyes
 
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  tongue  
 
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.  mad (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.
 

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

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.  smurf

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)


dmomhere
Veteran Member


Date Joined Feb 2005
Total Posts : 936
   Posted 9/8/2005 3:53 PM (GMT -7)   

HI again Erin

Thank you so much, not only for remembering and posting an example...but for doing such a darn good, efficient job of it :-) .

After reading it though, I'm thinking that it isnt what I have experienced, because when I do get them, they are in my hands and fingers (always both hands) and my fingers get all crooked and paralyse (picture the knarled fingers of an elderly lady plagued by severe arthritis.) The nodules are the size of...hmmmm, let's see - ever see those pins with the colorful little balls on the head of them??? They are about the same size as that and there are dozens and dozens of them in each hand...one next to another. This can last anywhere from 5 minutes to an hour and it is extremely painful. The only thing I have done so far is have the first person I see massage them out. My husband was mortified the first time it happened to me around him. He didnt know what to think. although I had already told him about them. I was 17 the first time it happened and it has been happening ever since 2-3 times per year. However, I haven't had any episodes for over 3 years now.....knock on wood. I hope someone will identify with these and I can finally find out what they are. Any doc I have ever mentioned it to has had no answer and has brushed it off. I haven't made too much of a fuss about it because they are infrequent...but I would very much like to know what the heck it is. Let me know what you thin erin...is this the same as you explained...or am I right in thinking it is different. Thank you so much for your time. Hope you are having a great day!


Dee            
 
Always have the courage to stand up for what you believe in and always have the confidence to stand behind it - anonymous


erin.K
Veteran Member


Date Joined Mar 2005
Total Posts : 3148
   Posted 9/8/2005 6:15 PM (GMT -7)   
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

dmomhere
Veteran Member


Date Joined Feb 2005
Total Posts : 936
   Posted 9/8/2005 6:34 PM (GMT -7)   
You are so kind to take such an interest in this Erin. Please don't go through too much trouble....remember...it is mostly out of curiousity  that I want to know now. I never get it more than a few times per year plus I havent even had it happen for over 3 years now. But I truly do appreciate your concern. As for your question....no - I haven't had this happen anywhere else than in my hands. And biopsies???? The nodules have never lasted more than an hour so it would be impossible to get a biopsie. Oh and I think i didnt explain the knarled finger thing right. It only happens when I get the nodules. After the nodules go away, my fingers return to normal. Although I always have swollen joints and a slight crookedness of my pinky and ring fingers. Isn't it weird????? I should add that my body is always doing weird things. Im kind of use to it now  LOL. Anyhow, I must thank you once again for your time, concern and help...if ever you need anything..give me a shout - you never know...maybe I can return the favor.
Oh and one final thing....nice to meet you  tongue .
What a wonderful and caring person you are. I am so glad to have met you.
Dee            
 
Always have the courage to stand up for what you believe in and always have the confidence to stand behind it - anonymous


effie
Regular Member


Date Joined Mar 2005
Total Posts : 344
   Posted 9/8/2005 6:50 PM (GMT -7)   
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

erin.K
Veteran Member


Date Joined Mar 2005
Total Posts : 3148
   Posted 9/8/2005 6:53 PM (GMT -7)   
boy Dee! you're right...you are weird!! LOL!!! this is so strange. what a freaky occurence these bumps are.
and to only happen a few times a year?? i wonder if it is something like shingles or an allergy?
now i see why the docs are confused. RA nodules last a good duration.

perhaps in the future someone will come across this thread and have the same thing.

at the least...this was the most interesting thing i've thought about in a long time!

it was really a pleasure to meet you as well!

i like detective work! when i was a nursing student last spring...this guy had a bacteria in a foot ulcer that the surgeons never heard of. i did some dirty work on bacteria and FOUND IT!!! i ran to the surgeons the next day and they were quite impressed! it was a bug called Proteus Mirabilis...and it's found in feces and decaying tissue (gross right?)...but i suggested to them that he most likely acquired this infection from stool incontinence (dribbled down his leg?). and they actually used my findings in their report!

so yea, i like the weird stuff. many docs and medical people take the easy way out and just give up or pass the problem on to someone else.
i like solving the puzzles

have a goodnight
erin

erin.K
Veteran Member


Date Joined Mar 2005
Total Posts : 3148
   Posted 9/8/2005 6:58 PM (GMT -7)   
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

Flopsie
Veteran Member


Date Joined Jun 2005
Total Posts : 1361
   Posted 9/8/2005 9:51 PM (GMT -7)   
Can anyone here tell that erin is feeling quite a bit better as opposed to last week? amazing what a good weekend with Honey can do. LMBO
Don't walk in front of me....I may not follow
Don't walk behind me....I may not lead
Walk beside me..and be my friend...
                                    Albert Carnus
 
and Lord, put your arm around my shoulder and your hand over my mouth
 
Help HealingWell.com continue to help others. Donate Today....http://www.healingwell.com/donate/
 
co-moderator for Arthritis and Anxiety/Panic
 

effie
Regular Member


Date Joined Mar 2005
Total Posts : 344
   Posted 9/8/2005 10:26 PM (GMT -7)   
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!!! :-) yeah tongue scool smurf :-) yeah

erin.K
Veteran Member


Date Joined Mar 2005
Total Posts : 3148
   Posted 9/9/2005 11:36 AM (GMT -7)   
hey ladies,

i am doing my best at sounded better! thank you for noticing. am trying to keep positive and just not think too far ahead and trying to make the best of each day.

i think a lot of why i sound better is that i got my schooling cleared up. i am allowed to return, they'll honor my grant and registration for grad school next fall. they are accepting my disability leave.

i had a lot of depression thinking i was going to be rejected.

struggling financially...but am managing to get by with the credit card payments. i am spending NOTHING!!! so hopefully SSD gets to me real soon. it will be almost 5 months! i really do not want to get to the point where i have zero dollars to my name.

hanging on best i can.

making myself as comfortable as possible during the day while having joint pain and gut discomfort. it is an all day affair taking all of these Crohn's meds.

so i look forward to my honey on the weekends....be grateful for all the things i have working in my favor....and trying not too get so down about not being able to work and go to school.

and saying everyday...next year will be better.

dmomhere
Veteran Member


Date Joined Feb 2005
Total Posts : 936
   Posted 9/9/2005 5:48 PM (GMT -7)   
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..
Dee            
 
Always have the courage to stand up for what you believe in and always have the confidence to stand behind it - anonymous


taintedangel
Regular Member


Date Joined Jun 2005
Total Posts : 303
   Posted 4/13/2006 9:57 AM (GMT -7)   
I think that's what I have going on. I haven't been diagnosed with RA as of yet, but i do have an appointment in a couple of weeks with a RA doctor. It started with all sorts of pain and not feeling well. I kept thinking the pain would go away it hasn't let me tell you that much in fact i feel like its getting worse. anyway, I noticed a knot right around my left knee mom thought it was just bone well its still there and I have a pretty good size knot on both my index fingers right above the knuckle, and my middle fingers right above the knuckle. kind of odd they are in the nearly the same spot and the most recent one is on my left shoulder. you can actually see it through the shirts. when i noticed that one i was like ok what the heck is going on this isn't normal. that's when i started mentioning it to my pcp and he said i should probably get these seen about by an RA doctor. I'm hoping to get some answers when i see the RA doctor cause i'm very concerned to say the least. Their weird little buggers too. They are hard knots the ones on my fingers aren't but maybe the size of a pea maybe a little bigger but the one on my knee and shoulder are about the size of a nickle and I think i have one around each elbow at least that's what it feels like. When i bend my elbows it looks like i have two elbows. I've had these for a long time never really thought much of it until these others started popping up and i started having more aches and pains than usual and i started doing more research on RA and thought i should probably have this seen about. anyway, wish me luck on my doctor's appointment. I hope your right about it being a tell tell sign of RA. i certainly don't want to go through another round of test and guessing did that when I was diagnosed as hypothroid and having Hashimoto's Disease and ITP which regards low blood platelets. arthritus does run in my family and i figure it certainly couldn't hurt to have things seen about. The earlier you catch it the better right?
New Topic Post Reply Printable Version
Forum Information
Currently it is Sunday, December 04, 2016 1:22 PM (GMT -7)
There are a total of 2,732,657 posts in 301,041 threads.
View Active Threads


Who's Online
This forum has 151200 registered members. Please welcome our newest member, MartiG.
287 Guest(s), 11 Registered Member(s) are currently online.  Details
George_, scifigal2k, BnotAfraid, MartiG, jdcd57, Mustard Seed, Randy Eichner, Broncofan18, Myself 09, Oranged, Lisa-Dionne


Follow HealingWell.com on Facebook  Follow HealingWell.com on Twitter  Follow HealingWell.com on Pinterest
Advertisement
Advertisement

©1996-2016 HealingWell.com LLC  All rights reserved.

Advertise | Privacy Policy & Disclaimer