A 67-year-old woman with rheumatoid arthritis was hospitalized because
of dysphagia and severe nodulosis. Over a two-year period the patient
had been treated with methotrexate. A computed tomography (CT) scan o
f the neck showed a 2 x 2 cm large tumour behind the top left lateral
thyroid cartilage. A biopsy taken during direct laryngoscopy showed it
was a rheumatic nodule. Treatment with colchicine reduced the patient
's dysphagia. As methotrexate is used increasingly in the treatment of
rheumatoid arthritis and as this particular drug causes rheumatic nod
ules in five to 10 per cent of the patients, it must be foreseen that
the incidence of nodules in the upper airways will increase.