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Medscape
03-07-2025
- Health
- Medscape
Rheumatoid Nodules: Rare, Recurrent, and Still a Challenge
Despite the rising incidence of rheumatoid arthritis (RA), extra-articular manifestations have become rare in the era of modern treat-to-target therapy. However, they still present clinical challenges — particularly in the case of rheumatoid nodules. In addition to the need to rule out serious differential diagnoses and address potential complications, especially those involving the lungs, these recurrent inflammatory granulomas can affect daily life not only cosmetically but also functionally. Christopher Edwards, MD, professor of rheumatology at University Hospital Southampton in Southampton, England, discussed the clinical relevance and management of rheumatoid nodules during the 2025 Annual Meeting of the European Alliance of Associations for Rheumatology. When Edwards began his career in rheumatology, the presence of rheumatoid nodules was considered a key diagnostic criterion for RA. If not found on the hands, clinicians often examined the elbows and Achilles tendons, which are also common sites. Histologically, rheumatoid nodules are granulomatous inflammatory lesions that evolve through multiple stages. While often subcutaneous, they can also be found on the sclera, larynx, heart valves, and — most significantly — in the lungs. Biopsy When Malignancy Is Suspected Pulmonary nodules can present diagnostic difficulties. 'I've seen patients who were initially told they had lung metastases,' Edwards recalled. Waiting for further imaging and biopsy can be highly distressing for patients. Granulomatosis with polyangiitis can also resemble rheumatoid nodules, further complicating the diagnosis. It is especially important to distinguish these nodules from infections such as tuberculosis. Patients with RA are at increased risk for infection due to both the underlying disease and immunosuppressive treatment. Like tuberculomas, pulmonary rheumatoid nodules can undergo central necrosis when exposed to tumor necrosis factor-alpha inhibitors, leading to cavitation or even pneumothorax. 'Any cavity in the lung can become infected,' Edwards cautioned. Diagnosing Peripheral Nodules Diagnosing peripheral rheumatoid nodules is usually straightforward. These nodules typically feel rubbery on palpation and are movable relative to the underlying tissue. Important differential diagnoses include gouty tophi, lipomas, epidermoid cysts, infectious granulomas, sarcoidosis, and neoplastic lesions. Imaging tools such as ultrasound or fine-needle aspiration can help clarify the diagnosis, particularly when gout is suspected. 'Biopsy is rarely required — only if there's concern about a neoplastic or malignant process,' Edwards explained. Better Disease Control, Fewer Nodules 'In my practice, I see very few nodules these days,' said Edwards. Epidemiological data support this trend: The 10-year cumulative incidence of subcutaneous nodules in RA patients decreased from 30.9% between 1985 and 1999 to 15.8% between 2000 and 2014. Multiple factors likely contributed to this decline, including the earlier initiation of more effective therapies and a reduction in smoking rates. Smoking remains a major risk factor for nodule development, along with long-standing, severe RA, male sex, and seropositivity for rheumatoid factor or anti-cyclic citrullinated peptide antibodies. 'Patients with nodules are almost always seropositive,' Edwards noted. These findings suggest that maintaining tight control of disease activity is more critical for preventing nodules than concerns about drug-induced nodulosis. Little Reason to Discontinue Methotrexate 'There was a time when we worried that methotrexate might be causing nodules,' Edwards said, referring to anecdotal reports of increased nodulosis after initiating methotrexate (MTX). 'But now we're using more MTX and seeing fewer nodules.' He emphasized that the presence of nodules alone should not prompt discontinuation of MTX. 'It wasn't a reason to stop methotrexate back then, and it's not a reason now — though in some cases, it may justify a more aggressive treatment approach.' Other medications — particularly tumor necrosis factor inhibitors like etanercept — have also been linked to nodule development, though Edwards suggested this may reflect reporting bias. 'It might not be causal,' he said. Often, treatment isn't necessary. 'Sometimes it's just a matter of observation,' Edwards noted. Painful or functionally limiting nodules may be managed with local glucocorticoid injections to reduce discomfort and soften the nodules. However, he admitted he had never personally injected a rheumatoid nodule. He also cautioned against injections over the elbow. 'There's something about the skin and the olecranon bursa that makes infections more likely in that area. I saw one patient who needed plastic surgery after an infection left a significant wound.' Rheumatoid nodules also have a tendency to recur. When to Consider Surgery 'Surgery can benefit some patients,' Edwards said. Surgical removal may be warranted for nodules that ulcerate, become infected, or impair function — such as large nodules on the thumb or fingertip that interfere with gripping. 'Patients are usually happy to regain function, even if the nodule comes back a couple of years later.' Nodules that are consistently irritated by shoes or clothing straps may also merit removal. Pulmonary rheumatoid nodules — unlike subcutaneous ones — often contain B cells and typically respond well to rituximab or abatacept. 'These lung nodules tend to shrink or stabilize with rituximab, and certainly, no new ones seem to develop,' Edwards noted. Case reports and small series have also documented improvement with Janus kinase inhibitors.
BBC News
19-06-2025
- Health
- BBC News
Southampton lung expert warns indoor air pollution is being overlooked
A leading respiratory expert has warned the dangers of indoor air pollution are being respiratory physician Dr Thom Daniels, from University Hospital Southampton (UHS), says the "invisible threat" may pose an even bigger risk to health than outdoor can trigger short-term respiratory symptoms and make existing conditions such as asthma warning comes as the Royal College of Physicians (RCP) publishes a new report linking air pollution to 30,000 deaths a year in the UK. "We know so much more about outdoor air pollution because it's so much easier to study," says Dr Daniels. "One monitor allows you to know about the air quality for thousands of people. But every single house is different and we spend 90% of our time indoors and until we understand better about indoor air quality, we'll be missing the majority of our air exposure." Particulates and harmful gases come from daily activities within the home such as cooking or using wood burning and other household cleaning products can also add to the problem. People with chronic lung conditions are advised to limit their use where possible."Burning your cooking on your hob really produces a lot of the very small material, particulate matter," continues Dr Daniels."Dust is unavoidable, there's always going to be dust. Cleaning products produce chemicals in the air."And another area that is really important is wood burning stoves. Everyone loves a wood burning stove - it's so lovely - but it really does produce a lot of indoor air pollution as well as outdoor." To understand how indoor air quality can be affected by everyday household tasks, I've borrowed an air monitor from Dr app tells me the air outside is good quality scoring 97 out of a possible 100. The higher the number the less measurable pollution is start with my indoor reading is about the same but it does not take long for things to go a piece of salmon, I light a fragranced candle to disguise the smell. A bit of vacuuming and spraying down the kitchen counter are also on the chores but surely the air quality starts to fall. Without burning the food it is down to 49 out of 100 - telling me the air quality is house just smells of cooking. I've never before thought of it as poor air quality. How low can you go? Curious to see what the monitor would show I decide to put two slices of bread into the toaster and crank it long whisps of smoke begin to fill the kitchen and the air quality is not long before the smoke alarm sounds and the smell of burned toast fills the entire indoor air monitor now reads zero, warning of severe pollution and telling me patients and members of sensitive groups may have to take emergency action. While poor air quality in the home is linked to household activities, which are usually short term, there is concern spikes in indoor air pollution could still be harmful."We do know that these spikes can induce changes in our bodies - so inflammation in the airways, in the cells of our airways and damage to the integrity of those airways to prevent other things getting in," warns Dr there is action you can take to reduce the levels of indoor pollution in your recommend always using an extractor fan when cooking and using the rear of the hob so that fumes go up the wall into the fan rather than towards the only dry, untreated wood at a high temperature will also help reduce emissions from wood the meantime, Dr Daniels is calling for more research into indoor air pollution to understand the problem we are all living with. You can follow BBC Hampshire & Isle of Wight on Facebook, X (Twitter), or Instagram.
BBC News
23-05-2025
- Health
- BBC News
Jersey: Hospital patients let down by Blue Islands' cancellations
David Thompson has a tumour on his right lung. He was travelling from Jersey to Southampton for a scan and biopsy to find out whether he has cancer when his flight was cancelled with less than an hour's flight was one of 29 between Jersey and Southampton which have been cancelled or delayed so far this year by Channel Islands airline Blue Thompson said he managed to reschedule his medical appointments but was "fearful" it wouldn't be possible. He had cancer seven and a half years ago and said he knew with a disease like cancer "every day counts". Blue Islands said it was "truly sorry" a small number of patient hospital flights had been disrupted in recent weeks. 'Exception rather than norm' A spokesperson from the airline said patient hospital travel was one of the most important services it provided for airline acknowledged the weekday morning flight from Jersey to Southampton was key to reaching hospital said since the beginning of this year it had two cancellations on this service – one for technical reasons and one for crew more had been cancelled for weather reasons, the company said, and one when Jersey airport was closed due to a security airline said: "Although we know it will come as no consolation to those whose journeys and hospital visits were impacted, such events are the exception rather than the norm." 'Upset me a lot' Jersey Hospital regularly sends patients to University Hospital Southampton for treatments it cannot provide Mr Thompson's partner shared his experience with Blue Islands in a Facebook group, he was astonished by the number of people who replied with similar stories, dating back to Thompson said it felt like the airline did not said the cancellation cost him £140 in hotel and taxi costs, but what concerned him most was that he believed there were three other people on the flight due to have PET scans - for cancer diagnosis or said: "One of them was a really older gentleman so, for him, it would have been a hell of a long day. "When we were collecting the baggage from the baggage carousel, he shed a tear. "That upset me a lot."Mr Thompson is still waiting for the results of his PET scan and biopsy. Four days after Mr Thompson's flight to Southampton was cancelled, Annette Jackson, travelling to get treatment for a degenerative eye condition, had a similar was booked on a 15:00 BST flight the afternoon before an appointment in Southampton when her flight was cancelled. She was put on a flight scheduled to leave three hours later, but it was delayed until 20:30 BST."I got to Southampton at 10 o'clock at night when I should have been there at 4 o'clock in the afternoon, very tired, very exhausted," she Jackson said Blue Islands claimed the flight was cancelled because of technical issues."They'd shoved us all on to the later flight, which was full and the same coming back," she Islands said it did not cancel flights at the last minute due to passenger said this not only impacted customers but came with significant financial costs. 'Very traumatic' Mrs Jackson said it could be "very traumatic" to spend five hours in an airport because of her sight loss."Luckily, my husband was with me or else it would have been really bad because I can't see anything in bright light," she Jackson said she was "dreading" her next flight to the UK for another medical appointment in eight weeks' time. The Jersey Consumer Council (JCC) said situations like this were "the tip of the iceberg" when it came to the way flight cancellations could impact Carl Walker said there had been growing problems in recent months, with increasing flight cancellations and a result, the JCC has launched a survey for passengers to share their experiences of flying with Blue Islands. Mr Walker said UK and EU law meant passengers on UK and EU-based airlines could claim more than £200 compensation for cancellations, but equivalent law did not exist in the Channel said because Blue Islands was a Channel Island airline, anybody using it was unprotected from a consumer Walker said: "The government needs to change the law, it either needs to create its own compensation scheme for any airline based in the Channel Islands or it simply needs to try and extend the the UK Law to cover the Channel Islands."This really does need urgent attention." 'It isn't acceptable' In 2020, Jersey's government loaned Blue Islands £10m to be paid back over six of this agreement was to help the airline keep providing islanders with "access to essential medical care".Mr Thompson said the government should be doing something to make sure people could rely on the service, and to make sure the money the health service spent on patient flights to Southampton was not wasted."It isn't acceptable," he said: "It's not about me, it's about everybody who needs that treatment in Southampton, they deserve better than this... because in a lot of cases it can be the difference."The BBC has approached the Government of Jersey for comment.
STV News
29-04-2025
- Health
- STV News
World-first clinical trial launched in the UK for a fridge-free vaccine
A world-first clinical trial has been launched in the UK for a fridge-free vaccine, which could greatly increase access to jabs. The Stablepharma tetanus-diphtheria vaccine (SPVX02) is completely stable at room temperature and the firm behind it says up to 60 other vaccines may benefit from the advanced technology. The first-in-human trial of the vaccine is taking place at the National Institute for Health and Care Research (NIHR) Southampton clinical research facility at University Hospital Southampton. One of the biggest barriers to people getting vaccines in some parts of the world is the 'cold chain' required to keep vaccines cold from manufacture to the point they are injected. The World Health Organisation (WHO) estimates that up to half of vaccines are wasted globally every year – largely because of a lack of temperature control and the logistics needed to support an unbroken cold-chain. UK-based biotech company Stablepharma has shown it can converts existing approved vaccines to fridge-free versions that can be stored for long periods of time at room temperature. Health and Social Care Secretary, Wes Streeting, said: 'For years, vaccines have been held back by the need to be stored in a fridge – causing endless amounts of wastage and making it difficult to deliver them to remote communities. 'But thanks to this Government's vision and our investment through the National Institute for Health and Care Research, all that could be about to change. 'We are leading the charge by pushing through the world's first trial for fridge-free vaccines. 'This could be a real game changer and lifesaver globally – as it unlocks new ways for poorer nations to deliver vaccines to their patients, where they're often needed the most. 'Groundbreaking science is amongst the things that Britain does best, and this innovation reaffirms our position as a world leader in vaccine development and research, boosting growth and economic security – the cornerstone of our Plan for Change.' The clinical trial is being led by Professor Saul Faust from the University of Southampton and Stablepharma chief development officer, Dr Karen O'Hanlon. Prof Faust said: 'It is fantastic to see cutting-edge UK science reach the milestone of a first clinical trial and to be able to give the opportunity for people living on the south coast to take part. 'This research will be an important step toward exploring whether this innovation could eradicate vaccine wastage and move away from the need for the cold-chain.' The trial is expected to complete this summer, with results published by the end of the year. Stablepharma hopes the new vaccine will be in use globally by 2027. Get all the latest news from around the country Follow STV News Scan the QR code on your mobile device for all the latest news from around the country
ITV News
29-04-2025
- Health
- ITV News
World-first clinical trial launched in Southampton for a fridge-free vaccine
A world-first clinical trial has been launched in the UK for a fridge-free vaccine, which could greatly increase access to jabs. The Stablepharma tetanus-diphtheria vaccine (SPVX02) is completely stable at room temperature and the firm behind it says up to 60 other vaccines may benefit from the advanced technology. The first-in-human trial of the vaccine is taking place at the National Institute for Health and Care Research (NIHR) Southampton clinical research facility at University Hospital Southampton. One of the biggest barriers to people getting vaccines in some parts of the world is the 'cold chain' required to keep vaccines cold from manufacture to the point they are injected. The World Health Organisation (WHO) estimates that up to half of vaccines are wasted globally every year – largely because of a lack of temperature control and the logistics needed to support an unbroken cold-chain. UK-based biotech company Stablepharma has shown it can convert existing approved vaccines to fridge-free versions that can be stored for long periods of time at room temperature. Health and Social Care Secretary, Wes Streeting, said: 'For years, vaccines have been held back by the need to be stored in a fridge – causing endless amounts of wastage and making it difficult to deliver them to remote communities. 'But thanks to this Government's vision and our investment through the National Institute for Health and Care Research, all that could be about to change. 'We are leading the charge by pushing through the world's first trial for fridge-free vaccines. 'This could be a real game changer and lifesaver globally – as it unlocks new ways for poorer nations to deliver vaccines to their patients, where they're often needed the most. 'Groundbreaking science is amongst the things that Britain does best, and this innovation reaffirms our position as a world leader in vaccine development and research, boosting growth and economic security – the cornerstone of our Plan for Change.' The clinical trial is being led by Professor Saul Faust from the University of Southampton and Stablepharma chief development officer, Dr Karen O'Hanlon. Prof Faust said: 'It is fantastic to see cutting-edge UK science reach the milestone of a first clinical trial and to be able to give the opportunity for people living on the south coast to take part. 'This research will be an important step toward exploring whether this innovation could eradicate vaccine wastage and move away from the need for the cold-chain.' The trial is expected to complete this summer, with results published by the end of the year. Stablepharma hopes the new vaccine will be in use globally by 2027.
