Swollen Lymph Nodes and RA

One must always be careful to not automatically attribute any new medical symptom with RA. There are, however, many comorbid (occurs alongside) conditions with an autoimmune disease like RA. These can include cardiovascular, lung, and eye issues among others. Another issue that may be related to RA is swollen lymph nodes.

Ever since being diagnosed and treated for RA, I’ve had bouts with swollen lymph nodes. Sometimes this can be a real pain in the neck literally. The lymph nodes under my jaws, neck, and armpits have been swollen and quite painful on and off over the past few years.

This is not uncommon when people are fighting a cold or flu but this happens to me when there are no symptoms of any common upper respiratory infection. At times the pain was quite distracting and even bad enough to wake me up during the night.

My experience with swollen lymph nodes

Several years ago a series of lymph nodes from under the jaw, down the neck, across the chest, and under the armpits were really bothering me. My rheumatologist called it lymphadenopathy that simply means “disease of the lymph nodes.”¹ This rather general definition doesn’t get at the cause of the changes in the lymph nodes.

After a physical exam, my rheumatologist said that I probably had some sort of infection caused by the immune-suppressing medications used to treat RA. This made sense at the time since the lymph system is part of the immune system and includes liquid-containing white blood cells that attack foreign invaders like bacteria and viruses.²

A chest x-ray to rule out sarcoidosis

The rheumatologist called for a chest x-ray to rule out sarcoidosis which is an autoimmune disease of the lymph system and commonly shows up as many swollen lymph nodes deep in the chest.³ The x-rays were negative and the doctor told me to keep an eye on the nodes. After a few months, I returned to my rheumatologist and told him that the nodes were the same. He found some nodes that were rather large including one being 3 centimeters and called for an ultrasound to image the culprit.

Calling in the ultrasound technician and radiologist

The ultrasound technician could not find it and she called in the radiologist on staff that day. She poked and prodded and moved the ultrasound wand all over the place without finding anything. She mentioned that a three-centimeter node was rather large and wanted to be sure that she didn’t miss it. I went away not thinking about it much anymore.

Visiting a hematologist per my doctor's recommendations

After another six months, I mentioned the swollen nodes again to my rheumatologist and this time he recommended that I see a hematologist since they are experts on blood and lymph system disorders. Little did I know that hematologists are also oncologists - doctors who treat cancers. That sent the stress level up a bit since I knew that biologics and other immune-suppressing treatments for RA were linked to higher levels of lymphoma. But I knew that the connection was slight and that helped ease the worry.

Results from my visit with the hematologist

The oncologist was wonderful and very reassuring, stating that it was likely not lymphoma but he wanted to rule it out. He ordered a CT scan with injected contrast and ran a large amount of blood tests...9 vials in all! At the follow-up visit, he told me the good news that he could not find anything and didn’t want to do a biopsy of the nodes. He did find an increased level of rheumatoid factor (RF) in my blood and said that I was probably experiencing an increase of disease activity and that lymph nodes can be impacted like this in RA patients.

How are swollen lymph nodes related to RA?

According to rheumatology researchers:⁴

“Lymph node enlargement is an important physical finding associated with RA and SLE [lupus] disease activity. Atypical locations and unusually large lymph nodes should raise clinical suspicion of another underlying disease.”

Can lymph nodes go through physical changes in RA patients?

These researchers found that 89 percent of examined RA patients displayed lymphadenopathy. Swollen lymph nodes were most commonly found in the axillary region around the armpit. When patients were in remission, swollen lymph nodes diminished. Other researchers noted the complex biological connection of the immune system and lymph nodes and argued that lymph nodes can undergo physical changes in RA patients.⁵ They argued for continued investigation into the role of the lymph system in RA.

There can be many reasons for swollen lymph nodes. But it appears that lymphadenopathy could be common with autoimmune diseases and that makes sense given the fact that the lymph nodes are part of the immune system. If you find swollen or painful lymph nodes, please speak to your doctor about this symptom.