Answered by: Dr Sashini Seeni
My mother has some nodules on the elbow joint and knees with inflammatory features (redness, pain), with a spongy consistency…
She went to the doctor and had a joint ultrasound, which did not show anything abnormal. The doctor assumed it was a lipoma, I thought they were rheumatoid nodules (I’m a medical student). Because the doctor showed no interest, saying that she had never seen anything like it, I asked my mother to test anti-ccp antibodies. But they came out negative and the rheumatoid factor was normal, too. However, the blood tests showed an inflammatory syndrome. Could you help me with a differential diagnosis?Do you think they could appear because of osteoarthritis? I’m going to schedule an appointment with another doctor. Thank you!
Hello, thank you for your enquiry.
Your question is about your mother having nodules over the elbow and knee joints with inflammatory features and spongy in consistency, where ultrasound and serology test showed no abnormalities, concern of having rheumatoid arthritis.
For your information, to diagnose rheumatoid arthritis, you may refer to ACR/EULAR classification criteria, with the content of:
Hence, you need a proper workup to diagnose rheumatoid arthritis. As for osteoarthritis, it may have signs like Heberden’s nodules and Bouchard’s nodes which is painful and hard in consistency, some may have Baker’s cyst over the popliteal fossa of knee.
There are a lot of causes which may develop such nodules as well, such as lipoma, bursitis, neuroma, ganglion, tenosynovitis, nodular fasciitis and many more.
Therefore, to find out the final diagnosis for the nodules your mother having, a more detailed history and workup are required. A proper physical examinations and investigations such as xray and MRI are essential as well.
We highly recommend you to present to hospital with your mother for further examinations and investigations, then a proper treatment plan will be given for a better outcome.
You also can contact us for an online consultation for assistance.
Thank you, we hope our answer has been helpful.