nodal osteoarthritis (of the fingers)

Clinical syndrome of Heberden's nodes & Bouchard's nodes & often 1st carpometacarpal joint. Epidemiology: predominantly women Genetics: family history is often positive Pathology: - bony proliferation in the absence of objective synovitis Clinical manifestations: 1) aching, discomfort & stiffness increased with use of fingers 2) Heberden's nodes 3) Bouchard's nodes 4) the 1st metacarpal joint at the base of the thumb is a common site, worsened by gripping & twisting movements 5) MCP joints are rarely involved 6) symptoms may improve with time secondary to reduced range of motion with bony enlargement 7) function is generally preserved Differential diagnosis: gout Management: 1) see osteoarthritis 2) local measures a) avoid knitting b) warm water soaks in the morning c) nylon Spandex stretch gloves at night 3) osteoarthritis of 1st metacarpal joint responds to splinting 4) local corticosteroid injection into single joint symptomatic out of proportion to others 5) capsaicin 0.025% applied QID

Related

Bouchard's node Heberden's node

References

Medical Knowledge Self Assessment Program (MKSAP) 11, American College of Physicians, Philadelphia 1998