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Heberden's nodes are hard or bony swellings that can develop in the distal interphalangeal joints (DIP) (the joints closest to the end of the fingers and toes). [1] They are a sign of osteoarthritis and are caused by formation of osteophytes (calcific spurs) of the articular (joint) cartilage in response to repeated trauma at the joint.
Osteoarthritis; Other names: Arthrosis, osteoarthrosis, degenerative arthritis, degenerative joint disease: The formation of hard knobs at the middle finger joints (known as Bouchard's nodes) and at the farthest joints of the fingers (known as Heberden's nodes) is a common feature of osteoarthritis in the hands. Pronunciation /
They are seen in osteoarthritis, where they are caused by the formation of calcific spurs of the articular (joint) cartilage. Much less commonly, they may be seen in rheumatoid arthritis, where nodes are caused by antibody deposition to the synovium. A Bouchard's node on the proximal interphalangeal joint of the index finger of a 64 year old man.
Common drug therapies, such as anti TNF treatment or other immunosuppressive drugs, for rheumatoid arthritis has shown little effect on the nodules. [23] In fact, it has been shown that Methotrexate, a drug often used in rheumatoid arthritis, is actually correlated with the increased risk of nodule formation. [ 13 ]
Osteoarthritis of the hand causes stiffness of the base of the thumb, alongside enlargement of DIP and PIP joints, leading to the formation of Heberden's nodes and Bouchard's nodes respectively. [6] Such firm and bony swellings at the finger joints are caused by the growth of osteophytes .
1. Steroid - options are intra-articular injection, oral steroid, or intramuscular injection of steroid. Intra-articular steroid + lido w/o (I like triamcinolone the best) 20 mg for small joints is perfect. For the intramuscular injection, I personally like 40 mg triamcinolone and 20 mg dexamethasone in the same syringe injected into the gluteus.
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