A seropositive nodular rheumatoid polyarthritis without arthritis, does it exist?

Introduction: The rheumatoid polyarthritis is the most frequent chronic polyarthritis. It affects essentially woman between 40 and 60 years old. Rheumatic subcutaneous nodules and tenosynovitis are usually associated with seropositive symptomatic rheumatoid polyarthritis. However, it is rare that they constitute the essential clinical expression of the disease. Case report: A 60-year-old woman was hospitalized for tumefaction of the dorsal face of the right hand evolved two months before. The clinical examination was found isolated subcutaneous nodules. The anatomopathological exam of one nodule ended in its rheumatoid origin and the MRI of a second one confirmed a tenosynovitis. Anti-CCP antibodies were positive. The patient has never suffered from arthralgias. The evolution was favourable under corticosteroid therapy, methotrexate and colchicine. Discussion: Rheumatic subcutaneous nodules and tenosynovitis are usually associated with seropositive symptomatic rheumatoid polyarthritis. It is rare that they constitute the essential clinical expression of the disease. Conclusion: The extra-articular appearances of the rheumatoid polyarthritis must not be underestimated especially since they can constitute—even rarely—the essential clinical expression of the disease.