The significance of subcutaneous nodules in rheumatoid arthritis.

The presence of subcutaneous nodules in rheumatic fever is of serious prognostic significance because, as they are pathologically similar to the Aschoff bodies found in the heart, they generally indicate severe cardiac damage and active infection. As a rule nodules appear after the onset of the rheumatic heart lesion. There is, therefore, practically always cardiac involvement in cases where nodules are found, and they may be regarded as presumptive evidence of carditis. Nodules develop occasionally, however, in cases in which no clinically demonstrable cardiac lesions exist. In 1889 Cheadle affirmed that the appearance of nodules was really the equivalent of a death sentence. While the prognosis is bad, it is not quite so serious as this suggests. Hayes and Gibson (1942), in a study of 167 patients with nodules, found that 163 had cardiac lesions. Fiftytwo (31 %) died during the attack, and the later mortality was double that of cases without nodules.