What Are Heberden's Nodes? Symptoms and Significance

Heberden's Nodes Are a Clinical Sign of Osteoarthritis

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

What are Heberden's Nodes in Hand Osteoarthritis?

Heberden's nodes are bony enlargements of the joint closest to the fingertip -- also known as the DIP joint or distal interphalangeal joint. The DIP joint is the joint just below the fingernail. Heberden's nodes may or may not be painful, but they are unattractive in appearance.

These bony growths are a classic sign of hand osteoarthritis. Heberden's nodes differ from the rubbery bumps seen on the finger joints in rheumatoid arthritis.

 Visible signs of osteoarthritis (OA) are an important element when the disease is being diagnosed. Diagnosis of other types of arthritis, such as rheumatoid arthritis and gout, often relies more heavily on laboratory tests. The hands include the third most commonly affected joint for osteoarthritis, following osteoarthritis of the knee and hip. 

Heberden's nodes were named after William Heberden who discovered the nodes, 

Heberden's Nodes Explained

In hand osteoarthritis, the cartilage in the finger joints is worn away. As it degrades, the cartilage becomes rough and the bones cannot glide smoothly past each other in the joint. When the cartilage is finally worn away enough, the bones grind upon each other when the joint is flexed. This leads to loss of the bone. The body reacts to losing bone by signaling it is time to grow new bone. But with the joint disrupted, the new bone growth is added as a node next to the original bone.

This results in the bony bump of a Heberden's node developing.

Treatment of Heberden's Nodes

The joint often is stiff, with a limited range of motion. It may be painful. Treatments are usually rest and sometimes splinting, plus pain relievers, heat or ice. Physical therapy may help. Surgery may be done to replace or fuse the joint.

While the Heberden's nodes may be unattractive, the whole joint must usually be addressed as the node appears after it is disrupted. There is no way to simply improve the appearance of the joint.

The Significance of Heberden's Nodes

In scientific studies, there has been a dispute over whether there is a correlation between Heberden's nodes and a specific subset of osteoarthritis, known as generalized osteoarthritis. A study in Osteoarthritis and Cartilage (2006) suggests, "In patients with Heberden's nodes, the OA starts with the subchondral ossification (mineralization and thickening of bone just under cartilage). Heberden's nodes are the specific manifestation of GOA (generalized osteoarthritis) in the distal finger joints."

There is another controversy too that surrounds Heberden's nodes -- whether Heberden's nodes are synonymous with DIP osteophytes. One study in the Annals of the Rheumatic Diseases (1998), suggests they are not synonymous.

Bottom Line on Heberden's Nodes

Amid the controversies, most resources agree that Heberden's nodes are most common in women who are post-menopausal.

Studies suggest that there is a genetic predisposition to developing Heberden's nodes, whereby the associated gene is dominant in women and recessive in men. This can mean that if your mother has Heberden's nodes, you are likely at a greater risk to get them if you develop hand osteoarthritis.

Sources:

Investigations in generalized osteoarthritis. Part 1: genetic study of Heberden's nodes. Irlenbuscg U. et al. Osteoarthritis and Cartilage. May 2006.
http://www.ncbi.nlm.nih.gov/pubmed/16443379

Investigations in generalized osteoarthritis. Part 2: special histological features in generalized osteoarthritis. Irlenbuscg U. et al. Osteoarthritis and Cartilage. May 2006.
http://www.ncbi.nlm.nih.gov/pubmed/16442315

Relation between Heberden's nodes and distal interphalangeal joint osteophytes and their role as markers of generalized disease. Cicuttini FM et al. Annals of the Rheumatic Diseases. April 1998.
http://www.ncbi.nlm.nih.gov/pubmed/9709182

Osteoarthritis of the hip and Heberden's nodes. McGoldrick and O'Brien. Annals of the Rheumatic Diseases. January 1989.
http://www.pubmedcentral.nih.gov/pagerender.fcgi?artid=1003675&pageindex=1#page

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

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