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Abstract
We report two cases of females with seropositive and deforming nodular rheumatoid arthritis. They responded well to TCZ therapy after failing to other anti RA therapeutics (DMRDs and biologics). The nodules disappeared following TZC in both patients but they reappeared in one patient after 5 months of cessation of the TCZ.
Highlights
Rheumatoid nodules (RNs) grow as subcutaneous painless lumps over the bony prominences, close to affected joints, or they can be attached to tendons or fascia
Nodules may appear in other sites such as the vocal cords leading to hoarseness, lungs, heart and other internal organs
The natural history of rheumatoid nodules is uncertain but they appear to modify with treatment of RA
Summary
Rheumatoid nodules (RNs) grow as subcutaneous painless lumps over the bony prominences, close to affected joints, or they can be attached to tendons or fascia. About 5% of RA patients may develop nodules in the first 2 years of onset, and the cumulative prevalence is about 25-35%. Despite the well established place of TCZ in RA, the literature is scanty in reporting its effect on the RNs. We were the first to report the disappearance of elbow nodules in a case of aggressive refractory RA nearly 2 years ago [6]. We were the first to report the disappearance of elbow nodules in a case of aggressive refractory RA nearly 2 years ago [6] That coincided with another exciting report by other researchers on the regression of pulmonary nodules in a female with RA [7]. In her country of origin she was treated with courses of methotrexate (MTX), hydroxychloroquine (PQL), salazopyrine (SSZ) and leflunomide (LEF) but never received any biologic treatment. Elbows (Figure 1) and the feet were noticed
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