Various Manifestations of Rheumatic Disorders: Case 2 Heberden Nodes

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 formation.

(Case and photograph courtesy of Dr Sonia Arunabh.)