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John from Prince George asks: I have been diagnosed with rheumatoid arthritis and have developed nodules on my elbows, hands and feet. Is this normal?

One of the manifestations of rheumatoid arthritis outside the joint is the development of rheumatoid nodules. These occur in just under 10% of patients with rheumatoid arthritis and is one of the more common skin manifestation of rheumatoid arthritis. They often occur on pressure surfaces e.g. elbow, but can occur elsewhere as well. For most individuals, they are asymptomatic and specific treatment is not necessary for them. Steroid injections or surgical removal is sometimes considered, although control of the inflammatory arthritis often improves the nodules too. Paradoxically, in some patients treated with methotrexate – the gold standard for rheumatoid arthritis treatment – the nodules can worsen, and stopping methotrexate can lead to improvement.