Nodule Formation in Rheumatic Disease.

The literature on nodule formation in rheumatic disease is confused by the absence of co-ordination of clinical data and pathological material. Nodules of one sort or another are found in many rheumatic syndromes, and also in conditions which are barely within the scope of that designation. Parkes Weber (1943) classified nodules into eight types: those occurring in acute rheumatism, rheumatoid arthritis, gout, xanthomata, calcinosis, amyloidosis, mucinous (in thyroid dysfunction), and those occurring in the Ehlers-Danlos syndrome of laxity, abnormal elasticity, atrophy, and friability of the skin and ligaments. While the types of nodule found in acute rheumatism and rheumatoid arthritis are becoming fairly well defined (Dawson, 1933; Collins, 1939; and Bennett, 1943), there is still much debate on their structure in fibrositis, Copeman and Ackerman (1944) believing them to be fatty herniations, and Elliott (1944) supporting the view that they are only areas of spasm of muscle fibres. It was, therefore, decided to keep separately careful clinical records and biopsy reports on all cases of rheumatic or pseudo-rheumatic disease where nodules were definitely palpable, and later to classify them clinically, comparing their clinical diagnoses with the findings of the pathologist. Twenty-seven cases have been so examined.