Subcutaneous rheumatoid nodules and serum rheumatoid factor without arthritis

SUBCUTANEOUS rheumatoid nodules and serum rheumatoid factor are diagnostic criteria of definite or classic rheumatoid arthritis. They are generally associated with chronic deforming arthritis and severe systemic manifestations of rheumatoid disease. The titer of rheumatoid factor usually parallels disease severity. This study describes a patient with multiple large subcutaneous rheumatoid nodules and high-titer serum rheumatoid factor without arthritis. Report of a Case A 56-year-old white man was admitted to University Hospitals of Cleveland on May 25, 1973, with the complaint of lumps in the area of both elbows for five years. These growths first appeared on the left and later on the right elbow as pea-sized growths. The swellings were painless and did not ulcerate or interfere with elbow function. The nodules grew larger and coalesced during the subsequent five years. Medical history disclosed an attack of polyarthralgias without actual swelling 12 years prior to hospital admission. Symptoms were completely