From the Guidelines
Heberden nodes are the correct term for what is being referred to as Eden and Bouchard nodules, with Heberden nodes appearing at the distal interphalangeal joints (DIPs) and Bouchard nodes at the proximal interphalangeal joints (PIPs). According to the evidence provided by 1, Heberden and Bouchard nodes are clinically defined as posterolateral firm/hard swellings, with Heberden nodes located at the distal IPJ and Bouchard nodes at the proximal IPJ. The study published in the Annals of the Rheumatic Diseases in 2009 1 further supports this definition, stating that Heberden nodes and Bouchard nodes associate with underlying structural changes of hand osteoarthritis (HOA), especially osteophyte.
Key Points
- Heberden nodes are located at the distal interphalangeal joints (DIPs) and are a sign of osteoarthritis in this joint.
- Bouchard nodes are located at the proximal interphalangeal joints (PIPs) and are also a sign of osteoarthritis in this joint.
- These nodes represent osteophytes (bone spurs) that form as a result of cartilage breakdown and bone remodeling in osteoarthritis.
- They typically present as hard, sometimes painful lumps that can cause joint stiffness and reduced range of motion.
Management
Treatment for Heberden and Bouchard nodes focuses on symptom management, as the nodes themselves are permanent structural changes that cannot be reversed. Management options include:
- Acetaminophen or NSAIDs like ibuprofen for pain
- Topical NSAIDs
- Joint protection techniques
- Hand exercises to maintain mobility
- Heat or cold therapy for temporary relief
It's essential to note that while these management strategies can help control symptoms and maintain hand function, they do not reverse the underlying osteoarthritis changes. The evidence provided by 1 emphasizes the importance of assessing and monitoring functional impairment in hand OA, as it may be as severe as in rheumatoid arthritis.
From the Research
Definition of Heberden's and Bouchard's Nodes
- Heberden's nodes are bony growths that occur on the distal interphalangeal joints (the joints closest to the fingertips) 2
- Bouchard's nodes are bony growths that occur on the proximal interphalangeal joints (the joints in the middle of the fingers) 2
Relationship with Osteoarthritis
- Heberden's and Bouchard's nodes are associated with underlying radiographic changes of osteoarthritis, particularly osteophytes (bony spurs) and joint space narrowing 2
- The presence of Heberden's and Bouchard's nodes is a common symptom of osteoarthritis of the hand 3, 4
Prevalence and Risk Factors
- The prevalence of palpable finger joint nodules (Heberden's and Bouchard's nodes) is higher in individuals with diffuse idiopathic skeletal hyperostosis (DISH) compared to controls 4
- Physically heavy work is a risk factor for the development of finger joint nodules, including Heberden's and Bouchard's nodes 4