Bouchard's Nodes Causes and Treatments

Bony Joint Nodules Seen With Hand Osteoarthritis

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Bouchard's nodes are bony enlargements of the middle joints of the fingers, also known as proximal interphalangeal (PIP) joints. These are the first joints immediately above the knuckles.

The nodes are a classic sign of osteoarthritis, or joint degeneration, of the hand. They were named after the French pathologist Charles-Joseph Bouchard who studied people with arthritis in the 19th century.

Bouchard's nodes are less common than Heberden's nodes, which are bony enlargements of the distal interphalangeal (DIP) joints closest to the fingertips.

An elderly woman with arthritic hands.

Camille Tokerud Photography Inc. / Getty Images

This article looks at the symptoms and causes of Bouchard's nodes and explains how the condition is diagnosed and treated.

Bouchard's Node Symptoms

Bouchard's nodes, like Heberden's nodes, may or may not be painful. However, they will typically affect the extent to which a joint can move, or its range of motion.

Over time, the accumulation of excess bone tissue can cause bones to misalign and become crooked. The fingers can also become swollen.

As the joint stiffens, a person's grip can weaken, making it difficult to do daily tasks like opening a jar, using a can opener, or even turning a car key.

Recap

Bouchard’s nodes are bony bumps on the middle joints of the fingers that can cause the joints to stiffen, misalign, and become weaker. They may or may not be painful.

Causes

Osteoarthritis most often affects the joints of the hands, knees, hips, lower back, and neck. When this happens, the tissues that normally cushion the joint space are worn away. Over time, a person will start to experience joint pain, stiffness, and even the visible enlargement of the joint.

In addition, the connective tissue (cartilage) can become rough, making it difficult for the joint bones to slip past each other. When enough cartilage is worn away, the bones begin rubbing together, often causing extreme pain and inflammation.

Joint damage and inflammation can lead to the excessive remodeling of bone tissue. Ossification, this part of this process responsible for bone formation, continues haphazardly and unchecked. This can cause unsightly nodules. Those affecting the PIP joint are called Bouchard's nodes.

Genetics has a probable role in the development of Bouchard's nodes as they are commonly seen in families. Also, women are more likely to be affected than men.

With that being said, the prime cause of Bouchard's nodes is the same as any other manifestation of osteoarthritis: the long-term wear and tear of joint tissues.

Recap

Bouchard's nodes are the result of osteoarthritis in which the loss of cartilage between the PIP joints can lead to excessive bone remodeling. Genetics may play a role in their development.

Diagnosis

A Bouchard's node is considered a characteristic sign of osteoarthritis, helping differentiate it from other types of arthritis such as gout or rheumatoid arthritis.

With the said, there are also bumps associated with rheumatoid arthritis and gout. People with rheumatoid arthritis may develop rubbery bumps on the thumb and knuckles called rheumatoid nodules. People with gout may develop crystallized lumps in the joint space called tophi.

Since there are no blood tests to diagnose osteoarthritis, the doctor will perform other tests to rule out rheumatoid arthritis and gout as causes.

These include blood tests to check for rheumatoid factor (RF) and anti-cyclic citrullinated peptide (CCP) antibodies seen in people with rheumatoid arthritis. Blood tests can also check for elevated uric acid levels if gout is suspected.

Joint fluid may also be obtained to check for uric acid crystals associated with gout.

A complete blood count (CBC) can be used to detect a high white blood cell count (WBC) consistent with inflammation. Because osteoarthritis is not associated with chronic inflammation, WBCs will usually be lower than with gout or rheumatoid arthritis, both of which are inflammatory.

Imaging tests, such as an X-ray to check for joint cartilage loss, can also help confirm the diagnosis.

Recap

An X-ray can detect joint cartilage loss in people with hand osteoarthritis. Because there are no blood tests for osteoarthritis, the diagnosis will typically involve the exclusion of other possible causes, including gout and rheumatoid arthritis.

Treatment

The treatment for Bouchard's nodes is similar to the approach used for hand osteoarthritis without nodes. This includes:

  • Resting the joint
  • Heat and ice therapy
  • Pain relievers like Tylenol (acetaminophen) or nonsteroidal anti-inflammatory drugs (NSAIDs) like Aleve (naproxen) or Advil (ibuprofen)
  • Topical capsaicin cream for minor aches and pain
  • Injections of steroids into the joint for severe cases

Joint immobilization may also be used during acute flare-ups to minimize joint movement.

Once a node has formed, it is not inherently painful but will likely increase any pain that occurs with movement. By this stage, therapy may be needed to improve joint mobility and prevent disability:

  • Physical therapy can help improve hand movement.
  • Occupational therapy can help improve your ability to perform certain activities of daily living.

Surgery is rarely used for Bouchard's nodes, particularly for cosmetic reasons.

Recap

Bouchard's nodes may be treated with rest, heat or ice therapy, oral or topical pain relievers, or steroid injections if pain is involved. Hand therapy can help improve joint mobility and prevent disability. Surgery is rarely used.

Summary

Bouchard's nodes are the bony overgrowth of the middle joints of the fingers caused by osteoarthritis. They occur when the loss of joint cartilage causes excessive bone formation. Bouchard's nodes may or may not be painful but typically cause joint stiffness, grip weakness, and misaligned, crooked fingers in severe cases.

The diagnosis involves lab and imaging tests that help differentiate osteoarthritis from similar conditions like gout and rheumatoid arthritis.

Bouchard's nodes can be treated with rest, ice or heat therapy, pain relievers, or steroid injections if there is pain. Hand therapy can help prevent disability and increase joint mobility.

Frequently Asked Questions

  • What are Bouchard's nodes?

    Bouchard's nodes are bony overgrowths, also called bone spurs, in the joints in the middle of the finger. They're caused by wear and tear of bone rubbing against bone from osteoarthritis in the hand.

  • What's the difference between Heberden's nodes and Bouchard's nodes?

    Heberden's nodes are bony enlargements in the joints closest to your fingernails. Bouchard's nodes are bony enlargements in the middle joints, above where you would wear a ring.

  • Can you get rid of Bouchard's nodes?

    Not completely. You can treat related pain with rest, pain relievers, and heat and ice therapy. The bump itself won't go away unless you have surgery to remove it, but that procedure is rarely performed.

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8 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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