Lipoid nodules in chronic rheumatoid arthritis nodulos lipoide in chronic arthritis rheumatoide

Abstract

LTHOUGH so-called rheumatoid nodules have long been recognized as A a diagnostic feature of rheumatoid arthritis, a survey of the literature reveals few references to lipoid nodules in this disea~e.l-~ In view of the rarity of such lesions and because none of the previous reports have included lipid analysis of these nodules, the following case is reported. CASE REPORTThe patient was a 58 year old white female who entered the hospital on October 13, 1954, with a history of numbness and paralysis of the entire left side of the body for two days. She had noted the onset of her complaints on awakening from sleep two nights before admission, and stated that there had been some improvement in the degree of paralysis of her left leg in the interim between onset and her admission to the hospital. She also complained of "lumps" in various regions of the upper body which were said to be especially bothersome over the upper thoracic spine and bilaterally in the preauricular area. The patient stated that these swellings had been present for approximately one year.The past history was characterized by the onset of migratory polyarthritis in 1925, following a miscarriage. The joint symptoms at that time had lasted one year. There had been a flare-up of the arthritis after each of two pregnancies in the ensuing three years. By 1932 deformities with ulnar deviation of the fingers of both hands were noted. Treatment through the years had been sporadic, but the patient had remained active despite her increasing joint disability. Salicylates comprised her chief medication until 1946, when she was started on Darthronal, 1 b.i.d., (each tablet containing 100,000 units Vitamin D), which she continued until her present admission.On physical examination she was a middle-aged, thin, white female, appearing chronically ill but oriented, coherent and intelligent. She presented typical advanced rheumatoid deformities of the wrists, metacarpophalangeal and interphalangeal joints of both hands to the point of aImost complete functional disability. The elbows, knees, ankles and feet likewise exhibited the changes of advanced rheumatoid disease. There were firm nodules over the left lateral olecranon region as well as over the left Achilles tendon. In addition, there were larger cystic nodules over the midline superior dorsal spine, the posterior left shoulder, both supraclavicular regions, the dorsal surface of the right proximal forearm and both dorsal surfaces of the wrists. The largest of these measured up to 5 cm. in diameter. There also were similar but smaller lesions over the right superior parasternal and preauricular areas bilaterally. All of the foregoing cystic lesions were firm but semifluctuant and not tender. Figure 1 shows a close-up view of the right supraclavicular and parasternal nodules.The neurologic findings were those of a mild left hemiparesis with increased deep reflexes, absent abdominal reflexes and motor weakness.Laboratory data included hemoglobins varying from 12.2 grams to 10.4 grams and WBC counts from 6,300 to ...