Bouchard's Nodes: Causes and Treatments

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

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

These nodes are actually bony enlargements of the middle joints of the fingers, also known as the PIP joints or proximal interphalangeal joints. The PIP joint 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.

You may have also heard of Heberden's nodes, which are similar bony swellings that develop at the distal interphalangeal joint, or DIP point, which is the joint closest to the fingertips. In general, Bouchard's nodes are considered less common than Heberden's nodes.

Cause of Bouchard's Nodes

Bouchard's nodes are a classic sign of hand osteoarthritis, or hand OA, and the hand is the third most commonly affected joint in OA, following the knee and hip. In OA of the hand, the articular cartilage in the joints is worn away. Since this cartilage normally provides a cushion between the bones of the joint, as the cartilage wears away, a person may start to experience pain and stiffness. 

In addition to wearing away, the cartilage becomes rough and is no longer a smooth surface for the bones to slip past each other. Once the cartilage is worn away enough, the bones rub against each other, which can be quite painful.

As this rubbing continues, the existing bone may be destroyed. Your body then attempts to repair this bone loss. But instead of making a smooth replacement, a bony node grows alongside the existing bone of the finger joint and this is how a Bouchard's node develops.

Significance of Bouchard's Nodes

Bouchard's nodes, like Heberden's nodes, may or may not be painful, but they are typically associated with a limited motion of the affected joint.

The nodes are strongly familial (meaning they are inherited), and most researchers believe they are caused by osteophytes, although some disagree. Even so, genetics plays only one role in the formation of OA, as generally OA is considered to occur from the wear-and-tear with aging. OA may also follow an injury to the affected joint.

It's worthy to note that the characteristic appearance of Bouchard's nodes and Heberden's nodes in the hand are significantly helpful in diagnosing OA.

That said, by the time you see a new Bouchard's node, significant damage has happened to the finger joint. In other words, 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 OA without nodes. This includes resting the joint, perhaps using a splint to keep from moving it too much, pain relievers like nonsteroidal anti-inflammatories (NSAIDs), and heat and ice therapy. These therapies are mostly done when the node is in the formation phase.

Once the node has formed, most people do not have any pain, although they usually report a restriction in motion and function, and the finger may appear crooked or deformed.

At this stage, due to affected joint stiffness and loss of range of motion, physical or occupational therapy may be needed. In severe cases, surgery can be done to replace or fuse the joint, but this is rare.

Lastly, it's important to note that 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.

A Word From Verywell

In the end, a Bouchard's node is considered a visible sign of osteoarthritis, which can help with diagnosis. This is unlike other types of arthritis, like gout or rheumatoid arthritis, that may rely more on laboratory tests for diagnosis.

That said, there are also visible signs in the hands of some people with rheumatoid arthritis and gout. For example, rubbery bumps (called rheumatoid nodules) may be seen on the thumbs and knuckles in people with rheumatoid arthritis. Likewise, people who develop frequent gout attacks for many years may develop tophi on the fingers (tophi are hard bumps filled with uric acid crystals that get deposited in the joint space). 

The good news is that a doctor can easily distinguish these signs from those seen in osteoarthritis. 

Sources:

Doherty M, Abhishek A. (2017). Clinical manifestations and diagnosis of osteoarthritis. Hunter D, ed. UpToDate. Waltham, MA: UpToDate Inc.

Dunkin MA. (n.d.). Arthritis Foundation: "What Your Hands Say About Your Health".

Leung GJ, Rainsford KD, Kean WF. Osteoarthritis of the hand I: etiology and pathogenesis, risk factors, investigation and diagnosis.J Pharm Pharmacol. 2014 Mar;66(3):339-46.

Rees F et al. Distribution of finger nodes and their association with underlying radiographic features of osteoarthritis. Arthritis Care Res (Hoboken).2012 Apr;64(4):533-8.

Continue Reading