Various Manifestations of Rheumatic Disorders: Case 2 Heberden Nodes

Bilateral swelling and pain in the distal interphalangeal (DIP) joints for severalmonths brought this 65-year-old woman to her physician. She complained alsoof stiffness in the region of the DIP joints when she arose in the morning andafter 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 Heberdennodes, which are a manifestation of osteoarthritis (OA).Initially, a single Heberden node usually appears; eventually, multiplenodes develop. Later, as OA progresses, Bouchard nodes are seen in the proximalinterphalangeal joints. These nodes may be associated with little or nopain for long periods, and women are affected far more often than men.The altered digits may reveal other abnormalities, particularly fixed flexiondeformities and radial or ulnar deviation at the DIP joint. Radiographicstudies show narrowing of the joint space, subchondral sclerosis, and osteophyteformation.

(Case and photograph courtesy of Dr Sonia Arunabh.)