Photo Quiz

Nontender Elbow Nodules

 

Am Fam Physician. 2016 Sep 1;94(5):375-376.

A 77-year-old woman presented with a longstanding history of daily pain and stiffness in multiple joints. She reported morning stiffness in her shoulders, knees, dorsal feet, and metacarpophalangeal joints that improved with hot showers. She did not have acute attacks of pain or constitutional symptoms such as fever, chills, or weight changes.

On physical examination, she had symmetric swelling, warmth, and tenderness of the second, third, and fourth metacarpophalangeal joints. She also had bilateral irregularly shaped, nontender, firm, fixed nodules over the extensor surfaces of her elbows (Figure 1).


Figure 1.

Question

Based on the patient's history and physical examination findings, which one of the following is the most likely diagnosis?

A. Epidermoid cysts.

B. Olecranon bursitis.

C. Rheumatoid nodules.

D. Tophaceous gout.

Address correspondence to Scott Cordts, MD, at scott.cordts@deaconess.com. Reprints are not available from the author.

Author disclosure: No relevant financial affiliations.

REFERENCES

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5. Nyhäll-Wåhlin BM, Turesson C, Jacobsson LT, et al. The presence of rheumatoid nodules at early rheumatoid arthritis diagnosis is a sign of extra-articular disease and predicts radiographic progression of joint destruction over 5 years. Scand J Rheumatol. 2011;40(2):81–87.

6. García-Patos V. Rheumatoid nodule. Semin Cutan Med Surg. 2007;26(2):100–107.

7. Baan H, Haagsma CJ, van de Laar MA. Corticosteroid injections reduce size of rheumatoid nodules. Clin Rheumatol. 2006;25(1):21–23.

8. McGrath MH, Fleischer A. The subcutaneous rheumatoid nodule. Hand Clin. 1989;5(2):127–135.

9. Higgins JC, Maher MH, Douglas MS. Diagnosing common benign skin tumors. Am Fam Physician. 2015;92(7):601–607.

This series is coordinated by John E. Delzell Jr., MD, MSPH, Assistant Medical Editor.

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