“…The development of extensive nodulosis during MTX therapy in patients with diseases other than RA is rare, 9 but reports include psoriatic arthritis (PsA), 19,20 systemic lupus erythematous (SLE), 21 and juvenile idiopathic arthritis (JIA) 22 . Accelerated nodulosis has also been reported in association with other drugs, such as tumor necrosis factor (TNF alpha) inhbitors, 14,23–25 azathioprine, 5,26 leflunomide, 9,27 aromatase inhbitors, 28 and tocilizumab 5,9,24,26,28–30 . Therefore, some have proposed the terminology “immunomodulatory agents induced nodulosis.” 31 There are several predisposing factors, such as male gender, smoking, high titers of rheumatoid factor (RF) and anticitrullinated protein antibodies (ACPA), severe articular disease, and genetic susceptibility (HLA‐DRB1) 10,23,29,31 …”