From the Guidelines
A Heberden's nodule is a bony enlargement that forms at the distal interphalangeal joints due to osteoarthritis, characterized by firm, fixed swellings on the sides of the fingertips, often causing fingers to become crooked or bent. These nodules are more common in women than men, especially after menopause, and often have a genetic component 1. According to the EULAR evidence-based recommendations for the diagnosis of hand osteoarthritis, Heberden nodes are a clinical hallmark of hand osteoarthritis, along with Bouchard nodes and bony enlargement with or without deformity 1. The management of Heberden's nodules focuses on pain relief with acetaminophen or NSAIDs like ibuprofen, topical diclofenac gel, and joint protection strategies, as well as heat or cold therapy to reduce discomfort 1.
Some key points to consider when evaluating Heberden's nodules include:
- They are a visible sign of degenerative joint disease and, once formed, are permanent features of the hand 1
- They can be associated with underlying structural changes of osteoarthritis, especially osteophyte formation 1
- The sensitivity and specificity of Heberden's nodes for osteoarthritis vary widely, but they become more useful when taken in combination with other osteoarthritis features 1
- The probability of a subject with osteoarthritis increases when Heberden's nodes are considered in combination with other factors, such as age, family history, and joint space narrowing 1
It's worth noting that the evidence provided also includes studies on pulmonary nodules, which are not directly related to Heberden's nodules. However, the most relevant and recent study on Heberden's nodules is the EULAR evidence-based recommendations for the diagnosis of hand osteoarthritis, which provides a clear definition and management strategy for these nodules 1.
From the Research
Definition of Herden Nodule
There is no direct information available about a "Herden nodule" in the provided studies.
Possible Causes of Nodules
- Nodules can be caused by various conditions, including cysts, acneiform lesions, dermal nevus, angioma, pyogenic granuloma, amelanotic melanoma, eccrine poroma, Kaposi's sarcoma, skin malignancy, or metastasis 2.
- Erythema nodosum is also a common consideration for red skin nodules 2.
- Cutaneous lymphoma, such as cutaneous diffuse large B-cell lymphoma, can also present with nodules or infiltrations of relatively fast growth 2.
- Nodular malignant melanoma can present as a solitary polypoid nodule without apparent pigmentation 3.
- Transitional cell-type papillary carcinoma of the lacrimal sac can manifest as a medial canthal skin lesion 4.
- Nodular (keloidal) scleroderma is a rare condition where keloidal-like nodules develop within areas of thickened skin in patients with progressive systemic sclerosis (PSS) 5.