Bilateral swelling and pain in the distal interphalangeal (DIP) joints for several
months brought this 65-year-old woman to her physician. She complained also
of stiffness in the region of the DIP joints when she arose in the morning and
after short periods (less than 15 minutes) of inactivity. A history such as this,
in conjunction with the appearance of the patient's hand, is typical of Heberden
nodes, which are a manifestation of osteoarthritis (OA).
Initially, a single Heberden node usually appears; eventually, multiple
nodes develop. Later, as OA progresses, Bouchard nodes are seen in the proximal
interphalangeal joints. These nodes may be associated with little or no
pain for long periods, and women are affected far more often than men.
The altered digits may reveal other abnormalities, particularly fixed flexion
deformities and radial or ulnar deviation at the DIP joint. Radiographic
studies show narrowing of the joint space, subchondral sclerosis, and osteophyte
(Case and photograph courtesy of Dr Sonia Arunabh.)