Effects of Second-line Drugs on the Progression or Regression of Rheumatoid Nodules

Abstract

Second-line drugs may have different effects on nodules than on synovitis. In this study, we have begun to evaluate the effects of these agents on rheumatoid nodules. The appearance, progression, or regression of rheumatoid nodules were studied in an open series of 119 patients with rheumatoid arthritis (RA) seen at an academic center over the last 20 years. Fifty-six of these patients had nodules during a mean period of observation of 5.4 years. During this time, 1-5 second-line drugs were taken. Our population had a higher prevalence of nodules (47%) than did patients in most previously reported series. New nodule formation and nodule progression were most often associated with methotrexate (n = 21, 68%) but were also noted during use of gold salts (n = 6, 18%) and hydroxychloroquine (n = 3, 8%). Nodule regression and even complete resolution of nodules was most often observed with hydroxycholoroquine (n = 14, 36%) and with sulfasazine (n = 6, 32%) and injectable gold (n = 5, 14%). Changes in nodules occurred without consistent relation to synovitis. Second-line drugs that may modify the articular aspects of RA may exert varying effects on nodules. These very different effects, if confirmed, suggest important differences in drug mechanisms of action on this basic manifestation of RA.