What Are Bouchard's Nodes?

Bouchard's Nodes Can Take Years to Develop

An elderly woman with arthritic hands.
An elderly woman with arthritic hands.. Camille Tokerud Photography Inc./Getty Images

What are Bouchard's Nodes?

Bouchard's nodes are bony enlargements of the middle joints of the fingers -- also known as the PIP joint or proximal interphalangeal joint. This is the joint that is the first one above where you would wear a ring, the one toughest to get a ring past when you slip it on or off.

Bouchard's nodes are a classic sign of hand osteoarthritis. Visible signs of osteoarthritis are an important aspect of diagnosis.

Unlike other types of arthritis that may rely more on laboratory tests, there are characteristic signs of osteoarthritis. Bouchard's nodes are different from the rubbery bumps that may be seen on the thumbs and knuckles with rheumatoid arthritis.

Bouchard's nodes, like Heberden's nodes, may or may not be painful, but they are typically associated with limited motion of the affected joint. The nodes are strongly familial (i.e., inherited or genetic) and most researchers believe they are caused by osteophytes -- although some disagree. Bouchard's nodes are considered less common than Heberden's nodes.

What Causes Bouchard's Nodes?

The hand is the third most commonly affected joint in osteoarthritis, following the knee and hip. In osteoarthritis of the hand, the articular cartilage in the joints is worn away. Generally, this is thought to be wear-and-tear with aging, but it may follow and injury to the affected joint.

The cartilage normally provides a cushion between the bones of the joint.

As the cartilage wears away in your finger joint, you may start to experience pain and stiffness. The cartilage is becoming rough and is no longer a smooth surface for the bones to slip past each other. Once it is worn away enough, the bones rub against each other, which is painful.

As this continues, the existing bone may be destroyed. Your body attempts to repair bone loss but instead of making a smooth replacement, a bony node grows alongside the existing bone of the finger joint. This becomes a Bouchard's node.

The Significance of Bouchard's Nodes

It is the characteristic appearance of Bouchard's nodes and Heberden's nodes that are significantly helpful in diagnosing osteoarthritis. By the time you see the new bony Bouchard's node, significant damage has happened to the finger joint. The osteoarthritis has progressed and taken its toll on the joint.

Treatment of Bouchard's Nodes

The treatment for Bouchard's nodes is similar for hand osteoarthritis without nodes. This includes resting the joint, perhaps using a splint to keep from moving it too much. Pain relievers and heat or ice may address the symptoms. Because the affected joint will be stiff or lose range of motion, physical therapy may be needed. In severe cases, surgery can be done to replace or fuse the joint.

While Bouchard's nodes may be unsightly, surgery isn't done for cosmetic purposes. The joint is already degraded by the time the node appears, and replacement or fusion is needed rather than removal of a bump.

Bouchard's nodes were named after a famous French pathologist, Charles-Joseph Bouchard, who studied arthritis patients in the 19th century.

Sources:

Heberden's and Bouchard's nodes. Colin J. Alexander. Annals of the Rheumatic Diseases. 1999;58:675-678.

"What Your Hands Say About Your Health," Mary Anne Dunkin, Arthritis Foundation. Accessed 2/5/16.

"Arthritis: Osteoarthritis of the Hand," The Hand Center of Western Massachusetts. Accessed 2/5/16.

Continue Reading