Understanding arthritis nodules
Arthritis nodules in older adults
Arthritis nodules are a common issue experienced by older adults with certain arthritis conditions, and understanding what they are, how they form and their impact on daily life can help to better manage the frustrating symptoms they can cause. Here, we are looking at the types of arthritis associated with nodules, their cause, symptoms and how these impact daily life, how they are usually diagnosed and treated, and how best to manage them.At Home Instead, our aim is to help people age positively and in place by bringing expert care to their home. For nearly 20 years, we have been providing the highest standard of care, and creating industry-leading training programmes for our Care Professionals that are accredited by nursing and medical professionals. Today, we are the world’s largest global domiciliary care network, supporting over 100,000 older adults with personalised, tailored care at home. So whatever questions you have about arthritis nodules, we can help.
What are arthritis nodules?
Arthritis is one of the most common health conditions experienced by older adults, thought to impact around 10 million people in the UK. The majority of people with arthritis are over 50 years old. Arthritis itself can cause joint pain, stiffness, swelling, reduced range of motion, reduced mobility and fatigue. In some people with arthritis, nodules may develop. These arefirm swellings of tissueunder the skin, usually near joints like the fingers, elbows and heels. They most commonly impact people with rheumatoid arthritis, and they vary in size, from a few millimetres to a few centimetres. They are usuallypainlessbut can be uncomfortable, and depending on their size, they may interfere with dexterity and movement, which can affect daily tasks.Arthritis nodules are not dangerous, but they could be an indication of rheumatoid arthritis, so they should be monitored by your GP. If you suffer from painful nodules or they affect your mobility, there may be treatments available that can make you more comfortable and support your independence. Speak to your GP if you experience pain from arthritis nodules, notice them growing rapidly or changing in appearance, or if they become red, swollen or infected. Regardless of pain, you should seek help from your GP if arthritis nodules affect your mobility or dexterity and interfere with your ability to do daily tasks.
What types of arthritis are associated with nodules?
The two types of arthritis most commonly associated with nodules are: Rheumatoid arthritis – This is the main condition linked to nodules, and around 20-25% of patients with rheumatoid arthritis are thought to develop nodules. Rheumatoid arthritis is a chronic autoimmune condition that causes the body’s immune system to attack its own tissues, leading to inflammation in the joints and other symptoms like pain, swelling, stiffness and tenderness, fatigue, weakness and fever. You can learn more about this in our guide to rheumatoid arthritis and life expectancy.Osteoarthritis – Osteoarthritis is the most common form of arthritis, causing the protective cartilage that cushions the joints to wear down over time. In this case, nodules are referred to as Heberden’s nodes. In people with osteoarthritis, half of female patients and 1 in 4 male patients will develop this condition in their hands by the age of 85, and Heberden’s nodes can develop alongside. Heberden’s nodes look like bumps at the ends of the fingers, and may cause additional symptoms such as pain, swelling, stiffness, restricted motion, and enlarged fingers. Osteoarthritis can also lead to Bouchard’s nodes, which are similar to Heberden’s nodes, except they form on the middle finger joint closest to the knuckles. They are usually more common in women than in men. You may find more information in our guide to if arthritis is a disability.
What causes arthritis nodules?
Arthritis nodules are most commonly associated with rheumatoid arthritis, but they can impact other types too. There are a number of potential causes for arthritis nodules:
- The body’s ongoing immune response can cause inflammation near the joints which leads to nodules forming over years
- Friction or pressure on joints, making certain areas more prone to nodules over time
- The presence of certain antibodies like rheumatoid factor, which are more common in individuals with rheumatoid arthritis – a 2010 study found that in cases that were rheumatoid factor positive, there was more extensive radiographic damage to joints after 5 years
- Certain medications, such as methotrexate, could potentially lead to small nodules forming near the finger joints (thought to affect around 8% of patients on methotrexate), but keep in mind that this is never a reason to stop taking methotrexate unless advised to do so by a medical professional, as this is an important and necessary treatment for some
- Smoking – it is believed that those who develop nodules are more likely to be smokers, and research suggests a strong link between smoking and nodules in early rheumatoid arthritis, particularly in those who have smoked for more than 20 years
In those with Heberden’s nodes, risk factors include being older, female, having had long-term repetitive stress to finger joints, prior joint injuries or surgeries, family history of osteoarthritis or Heberden’s nodes, and being overweight.
What are the symptoms of arthritis nodules, and how do these impact daily life?
The primary symptom of arthritis nodules is the development of firm, painless lumps under the skin near the joints. Although these nodules usually will not cause any direct issues, they can lead to complications such as:
- Discomfort if nodules press on nerves
- Joint inflexibility, such as not being able to grip, write or walk properly
- Reduced self-confidence due to visible lumps
- Lumps becoming red, tender or irritated due to rubbing
- Curved fingers if nodules develop only on one side, limiting function
- Fatigue due to impaired mobility (learn more in our guide to arthritis and fatigue.)
How are arthritis nodules diagnosed and treated?
Arthritis nodules are fairly easy to diagnose as they are usually visible and distinctive. This is typically done by looking at the person’s medical history, doing a physical examination of the lumps that form, X-rays or imaging to assess any joint damage, or blood tests to confirm rheumatoid arthritis or identify markers linked to inflammation. If there is any concern over infection or confusion about what a lump may be, a doctor may arrange a biopsy.Treatment options for arthritis nodules will depend on what the complications are and how these impact daily life, such as mobility issues or curved fingers, and will usually involve treating the underlying arthritis. People with arthritis or arthritis nodules might be offered:
- Medications such as nonsteroidal anti-inflammatory drugs (NSAIDs) or disease-modifying antirheumatic drugs (DMARDs) to reduce inflammation
- Arthritis medications other than methotrexate, which has been linked to nodules
- Corticosteroid injections to shrink nodules
- Surgical removal of nodules
- Appointments with a rheumatologist to tailor treatment and address specific issues
- Laser therapy – one study found that low-level laser therapy reduced pain and swelling and increased mobility in people with Heberden’s nodes
If nodules are painless and do not interfere with movement or comfort, then they usually do not require treatment.
How can arthritis nodules be managed in daily life?
Your doctor might adjust your arthritis medications in order to reduce inflammation which can slow the growth of nodules. For arthritis nodules, you may also be advised to rest the affected areas, wear a splint or orthotic device to support your joints, use adaptive devices to make life easier, alternate heat and cold on the affected areas, or see a hand therapist for specific exercises that might help. If needed, wearing padded clothing and comfortable shoes could help to protect any arthritis nodules that could become irritated by rubbing. It can help to avoid activities or positions that put prolonged pressure on joints and nodules, and some of the recommended lifestyle changes that can limit the effects of arthritis include:
- Eating a healthy, anti-inflammatory diet rich in foods like omega-3 fatty acids, fruits, vegetables and whole grains
- Keeping joints moving with low-impact exercises like swimming or walking
- Maintaining a healthy weight to reduce stress on arthritic joints
- Undergoing occupational therapy to learn new ways of moving effectively
- Taking pain relief when needed
- Exploring different types of therapy to learn ways of coping with the stress of living with this condition
You can learn more in our guide to living with arthritis.
Where can people with arthritis nodules get more support?
If you live with arthritis nodules that impact your daily abilities, it is important to speak to your GP about potential treatments and home adaptations, and build a strong support network of family, friends and caregivers who can help if you need it.For more advice, resources and support, it helps to reach out to your local council to find out what they may be able to do for you. Some resources that can also help include:
- Age UK – This organisation has information on arthritis and advice on financial support that you may be able to claim for if you live with this condition. You can learn more on their website.
- Arthritis Action – This organisation provides information on how to live well with arthritis, and resources like cost of living support. You can learn more here.
- Versus Arthritis – This organisation provides online resources and a helpline for anyone living with arthritis. You can learn more on their website, or call their helpline on: 0800 5200 520 (lines open Mon-Fri, 9am-6pm)
A professional home carer could also provide visiting care or live-in support to help manage the symptoms of arthritis, including nodules. Our experienced, supportive Care Professionals at Home Instead can provide:
- Encouragement and reminders to move around regularly and move affected joints (if recommended by a GP)
- Reminders to take arthritis medications
- Help with meal planning, housekeeping and other daily home tasks that are often more challenging and painful for a person with arthritis
- Help with personal care activities that can be more difficult and risky for older adults with arthritis
- Support when using assistive devices or making home adaptations to keep the home environment safe for someone with arthritis
Our Care Professionals can be a great source of support for those living with arthritis or arthritis nodules. By providing mobility assistance and specialist arthritis care at home, we can help older adults with this condition to maintain their quality of life and continue living independently at home for as long as they would like to. Reach out to your local Home Instead office to find out more. We’re an award-winning home care provider and part of a worldwide organisation devoted to providing the highest-quality relationship-led care for older people in their own homes. Arranging care for yourself or your loved one shouldn’t be stressful, so whatever questions you would like answered, feel free to reach out to the Home Instead team to discuss your needs.