Nodal Osteoarthritis

Nodal osteoarthritis is the most common type of osteoarthritis, predominantly affecting women in their sixth decade of life, with a strong genetic component that influences which joints develop painful bony nodules.

Table of contents

• What Is Nodal Osteoarthritis?
• Who Gets Nodal Osteoarthritis?
• What Causes This Condition?
• Symptoms and Affected Joints
• How Is It Diagnosed?
• Treatment Options

What Is Nodal Osteoarthritis?

Nodal osteoarthritis is by far the most common type of osteoarthritis, a degenerative disease that affects the joints^[4][8]. Osteoarthritis leads to the breakdown over time of smooth, protective cartilage on the ends of bones, so bones rub together, causing pain^[1].

What makes nodal osteoarthritis distinctive is the development of bony lumps called nodes on the finger joints. When these growths appear on the middle joint of one or more fingers, they are called Bouchard’s nodes. When located at the joint near the fingertip, they are called Heberden’s nodes^[1][9]. These nodes are small, pea-sized bony growths that develop as the body responds to cartilage breakdown by growing new bone at the joint^[9].

Who Gets Nodal Osteoarthritis?

Nodal osteoarthritis commonly affects white females, with the female-to-male ratio being about 10:1^[4][8]. The condition typically appears in the sixth decade of life, which means most people develop it in their 50s^[4][8].

About half of all women and one-quarter of all men will experience the stiffness and pain of osteoarthritis of the hands by the time they are 85 years old^[1]. However, more than half of the patients with Heberden’s nodes and osteoarthritis are diagnosed before the age of 65 years^[15].

White individuals are more often affected than African Americans^[1]. Osteoarthritis of the hands is quite common, with Heberden’s nodes being a common symptom of this condition^[9].

What Causes This Condition?

There is a strong genetic element to nodal osteoarthritis. Family studies suggest a polygenic mode of inheritance or possibly a dominant trait with variable penetrance^[4][8]. This means that some people inherit the tendency to develop osteoarthritis, usually at a younger age^[1].

Mechanical factors have some role in determining which joints are involved^[4][8]. The disease often coincides with menopause in females. However, there is no clear correlation with hormone levels and hormone replacement is not beneficial^[4][8].

Several other factors can play a role in developing hand osteoarthritis, including:

• Age: The older you are, the more likely you are to have hand osteoarthritis^[1]
• Weight: Obese people are more likely to have hand osteoarthritis than thinner people^[1]
• Injuries: Even when properly treated, an injured joint is more likely to develop osteoarthritis over time. Fractures and dislocations are among the most common injuries that lead to arthritis^[1]
• Joint issues: Joint infections, overuse, loose ligaments, and poorly aligned joints can also lead to hand or wrist arthritis^[1]

Symptoms and Affected Joints

Nodal osteoarthritis most commonly affects three parts of the hand: the base of the thumb where the thumb and wrist join, the joint closest to the fingertip (called the distal interphalangeal joint or DIP joint), and the middle joint of a finger (called the proximal interphalangeal joint or PIP joint)^[1].

The bony swelling can affect either the lateral or midline aspects of the joint or both. Multiple nodes can be present on one digit, and the nodes can affect one or many digits^[15]. Nodes most often affect the middle finger or thumb of both hands. They may grow slowly or rapidly^[15].

Symptoms of nodal osteoarthritis can include:

• Pain: At first, pain will come and go. It worsens with use and eases with rest. Morning pain and stiffness are typical. As the osteoarthritis advances, the pain becomes more constant and may change from a dull ache to a sharp pain. It may start waking you up at night^[1]
• Stiffness and loss of motion: As arthritis progresses, you may lose the ability to open and close your fingers completely^[1]
• Bumps at the ends or middle of your fingers: Bony lumps form on the finger joints^[9]
• Swelling: Your body may respond to constant irritation and damage to the tissues surrounding the joint by swelling and becoming red and tender to the touch^[1]
• Enlarged, stiff fingers: With worsening osteoarthritis, daily activities can become difficult and your finger joints may lose their normal shape^[9]
• Crepitus: When damaged joint surfaces rub together, you may feel grinding, clicking or cracking sensations^[1]

The nodes may become inflamed and painful but are often painless and unnoticed^[15]. It may be difficult to perform daily tasks, like opening bottles or fastening buttons. You may feel frustrated at your limited range of motion^[9].

How Is It Diagnosed?

The diagnosis of nodal osteoarthritis is usually made clinically due to the characteristic appearance of the nodes^[15]. Your healthcare provider can diagnose osteoarthritis and Heberden’s or Bouchard’s nodes by examining your hands^[9].

Your physician may begin by asking you to describe your symptoms, and when and how the condition started. It is important for your physician to know how the condition is affecting your work and daily life, as well as about other medical conditions and whether you are taking any medicines^[16].

Imaging may be performed on the affected digit:

• X-rays may show such things as cartilage loss, bone damage and bone spurs. However, there is often a big difference between the severity of osteoarthritis that the X-ray shows and the degree of pain and disability you have. X-rays may not show early osteoarthritis damage before much cartilage loss has taken place^[16]. A plain X-ray of the affected joint may show osteophytes (bone spurs), although correlation is poor with clinical Heberden nodes^[15]
• Ultrasound scanning reveals osteophytes, synovitis (inflammation of the joint lining), and bony erosions of osteoarthritis^[15]
• Magnetic resonance imaging (MRI) may confirm the diagnosis of arthritis in the affected digit^[15]

Treatment Options

There is no specific treatment to repair a Heberden or Bouchard node^[15]. Treatment is designed to relieve pain and restore function^[16]. Your healthcare provider may recommend a combination of approaches:

Non-drug therapies:

• Rest your hand^[9]
• Wear a splint or orthotic device (orthosis) to help support your finger joints^[9]
• Use heat, such as paraffin wax or warm compresses on your hand. You can alternate heat therapy with cold therapy to ease pain, or use heat before activity and ice after activity^[9]
• See a hand therapist, who can teach you exercises to keep your hand mobile while protecting your joints. Continuing to use your hand in safe ways is important. Therapists can also teach you about adaptive tools to help you continue to use your hands for daily activities^[9]
• Physical or occupational therapy may help because changing the way you do things with your hands may help relieve pain and pressure^[16]

Drug treatments:

• Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen or naproxen, and acetaminophen (Tylenol) are often available as pills, syrups or lotions^[9][16]
• Counterirritants such as capsaicin or menthol^[9]
• Steroid injections can also ease pain^[9][16]

Surgery:

If conservative measures fail, surgery may be necessary. Several surgical options are available^[16]:

• Surgery may be used to drain or remove the cysts associated with the nodes and to remove excess bone growth^[16]
• Joint fusion, a way of stiffening the problem joint, may be used to correct deformities that interfere with function or that are cosmetically unacceptable^[16]
• A joint replacement may be advised^[16]

If Heberden’s nodes and other osteoarthritis symptoms bother you, and nonsurgical options haven’t helped, talk to your healthcare provider. You may want to consider surgery^[9].