Bouchard's Nodes: Causes and Treatments

Bony Joint Nodules Seen With Hand Osteoarthritis

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

Bouchard's nodes are a classic sign of osteoarthritis (OA) of the hand. They were named after the French pathologist, Charles-Joseph Bouchard, who studied arthritis patients in the 19th century. Bouchard nodes are bony enlargements of the middle joints of the fingers, also known as proximal interphalangeal (PIP) joints. These are the first joint immediately above the knuckles where you would wear a ring.

Heberden's nodes are similar bony swellings that develop at the distal interphalangeal (DIP) joint closest to the fingertips. Bouchard's nodes are less common than Heberden's nodes.

Symptoms

Bouchard's nodes, like Heberden's nodes, may or may not be painful but will typically affect the range of motion of a joint. Over time, the accumulation of excess bone tissue can cause bones to misalign and become crooked.

When this happens, it can often be difficult to do daily tasks like opening a jar, using a can opener, or even turning a car key.

Causes

The joints of the hand are the third most common structures affected by OA, just after the knees and hips. In OA of the hand, the articular cartilage in the joints will have begun to wear away, removing the tissues that normally cushions the joint space. As this happens, a person will start to experience pain, stiffness, and even the visible enlargement of the joint. 

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

Joint damage and inflammation can lead to the excessive remodeling of bone tissue, known as ossification. As the ossification continues haphazardly and unchecked, unsightly nodules can develop. Those affecting the PIP joint are called Bouchard's nodes.

Genetics appear to play a role insofar as the nodes are commonly seen in families. Women are also 10 times more likely to be affected than men.

With that being said, the prime trigger for their development is the same as any other form of OA: the long-term wear and tear of joint tissues.

Diagnosis

A Bouchard's node is considered a characteristic sign of OA, helping differentiate it from other types of arthritis, like gout or rheumatoid arthritis (RA). Lab tests would also be used to confirm the diagnosis.

With that being said, there are also bumps commonly associated with RA and gout. Rubbery bumps, called rheumatoid nodules, may be seen on the thumbs and knuckles in people with RA. Likewise, people with frequent gout attacks may develop crystallized lumps in the joint space called tophi

Simple blood, lab, and imaging tests can help distinguish the various types of arthritis.

A complete blood count (CBC) may be used to detect a high white blood cell count (WBC) consistent with inflammation. Because OA is not associated with chronic inflammation, the WBC will usually be lower than gout and RA, both of which are inflammatory.

Imaging tests may help differentiate rheumatoid nodules and Bouchard's nodes, while blood and tissue sample can help identify the uric acid crystals associated with gout and gout tophi.

Treatment

The treatment for Bouchard's nodes is similar for hand OA without nodes. This includes:

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 exacerbate any pain that occurs with movement. By this stage, physical or occupational therapy may be needed to better ensure joint mobility and prevent disability

In severe cases, surgery may be needed. Depending on the severity of symptoms, debridement (the smoothing of bone tissue) may be pursued. More commonly, arthrodesis (joint fusion) will be performed to help ease irretractable pain.

Surgery is rarely, if ever, used for cosmetic purposes.

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Article Sources
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