A case of rheumatoid nodules in the buccal subcutaneous : A novel case report of review and the literature

Methotrexate (MTX) has been reported to be effective for the treatment of rheumatoid arthritis (RA) when a weekly low dose is administered to patients. We carried out microscopic examination of a biopsied specimen suspected of being Wegener's granulomatosis, IgG4-related disease, or malignant lymphoma. Finally we diagnosed a rheumatoid nodule because his medical history included treatment with MTX. Then we immediately discontinued the MTX and his rheumatoid nodule disappeared after 2 months. Rheumatoid nodules are granulomatous nodules that appear subcutaneously and in tendons in the active phase of RA and commonly occur on the exterior part of the elbow joint and the back of the head where subcutaneous tissue is subject to recurrent pressure against bone. The development of an intraoral rheumatoid nodule in the maxillofacial region of a patient with RA who received MTX has not been few reported. To date, this patient has been followed up for 6 years without recurrence.