Bouchard's Nodes Causes and Treatments

Bony Joint Nodules Seen With Hand Osteoarthritis

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.

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

Bouchard'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

Osteoarthritis most often affects the joints of the hands, the knees, the hips, the lower back, and the neck. In OA of the hand, the articular cartilage in the joints begins to wear away, removing the tissues that normally cushion the joint space. As this happens, a person starts experiencing pain, stiffness, and even visible enlargement of the joint.

In addition, the cartilage becomes rough, making it difficult for the joint bones to slip past each other. When enough cartilage is worn away, the bones 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 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 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, such as gout or rheumatoid arthritis (RA). Lab and imaging tests (e.g., X-ray) are done 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 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.

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

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