From the Guidelines
Osteoarthritis of the hands is associated with several characteristic changes, including the development of mucous cysts (mucocoeles), Heberden's nodes, Bouchard's nodes, joint space narrowing, subchondral sclerosis, and osteophyte formation, which can lead to decreased range of motion, pain, stiffness, and reduced grip strength 1. The hand and skin changes that occur with osteoarthritis (OA) of the hands are:
- Mucocoeles: small, fluid-filled sacs that develop on the dorsal aspect of the distal interphalangeal (DIP) joints
- Heberden's nodes: bony enlargements of the DIP joints
- Bouchard's nodes: bony enlargements of the proximal interphalangeal joints
- Joint space narrowing
- Subchondral sclerosis
- Osteophyte formation
- Thin and shiny skin over affected joints
- Decreased range of motion
- Pain
- Stiffness
- Reduced grip strength Mucocoeles can cause nail deformities if they press on the nail matrix, and they may occasionally rupture or become infected 2. Treatment options for mucocoeles include aspiration, corticosteroid injection, or surgical excision if they cause significant symptoms or cosmetic concerns, but recurrence is common unless the underlying joint degeneration is addressed 1. It is essential to consider the latest recommendations for the management of hand OA, which emphasize a multimodal approach, including non-pharmacological, pharmacological, and surgical treatment options, as outlined in the 2019 EULAR recommendations 1.
From the Research
Hand and Skin Changes in Osteoarthritis (OA)
- Osteoarthritis (OA) of the hands can lead to various hand and skin changes, including mucocoeles 3, 4.
- Erosive hand OA (EHOA) is a distinct phenotype characterized by severe clinical onset and progression, leading to joint damage, disability, and reduction of quality of life 3.
- Clinical signs of inflammation associated with EHOA include the acute onset of pain, swelling, and redness, as well as radiographic features such as central erosion, saw-tooth and gull-wing lesions, and rarely, ankylosis 3.
- Hand OA can present with changes to the bone, ligaments, cartilage, and synovial tissue, which can be observed using radiography, ultrasonography, or MRI 4.
- The condition is heterogeneous and multifactorial in etiology, with genetic studies, clinical trials, and prospective imaging studies providing insights into the pathogenesis of hand OA 4.
Mucocoeles and Other Skin Changes
- While the provided studies do not specifically mention mucocoeles, they do discuss the various clinical manifestations of hand OA, including pain, functional limitations, and changes to the bone, ligaments, cartilage, and synovial tissue 3, 4.
- The development of mucocoeles, which are benign cysts that can occur on the hands, may be related to the joint damage and inflammation associated with hand OA, but further research is needed to confirm this association 3, 4.