Subcutaneous Nodules of Rheumatoid Arthritis with Lipoid Deposition.

Weber and Freudenthal (1936-7), Weber (1943, 1944, 1947, 1948), and Fletcher (1946, 1947) have noted the rare occurrence of subcutaneous nodules in rheumatoid arthritis which consisted almost entirely of lipoid, and have designated such cases by various names to differentiate them from the " common " type of rheumatoid arthritis subcutaneous nodule. During the clinical examination of seventy cases of .chronic rheumatoid arthritis in Cape Town, twenty cases were found to have one subcutaneous nodule or several nodules (Horwitz, 1948, 1949). Eleven nodules were removed by biopsy (from eight cases), and their macroscopic and histological features were examined. One of these nodules was found to differ from the other ten in being composed almost entirely of lipoid and thus resembling the two cases described by Weber and Fletcher. The case is described fully below. When the descriptions were compared it seemed that there might be some common pathogenesis of the pathological changes observed in the nodule of this case and in the nodules described by Weber and Fletcher. Experimental staining with scarlet red of frozen sections of an additional nine nodules (from seven cases of rheumatoid arthritis) showed that lesser degrees of lipoid deposition are in fact commonly present in most " ordinary " nodules in rheumatoid arthritis. It is, therefore, suggested that this lipoid deposition forms the basis of the later development of those nodules encountered with grosser degrees of lipoid deposition. If so, then there is no justification for using special nomenclature to designate the lipoid nodule in the present case, or in the similar cases recorded in the literature.