Heberden’s nodes are bony bumps that develop on the joints at the tips of the fingers. These nodes are typically associated with osteoarthritis. However, rheumatoid arthritis (RA) may affect those same joints, making osteoarthritis and RA difficult to distinguish. Here, we will take a closer look at the signs, symptoms, and causes of Heberden’s nodes and examine their relationship to RA.
If you develop any bony growths with RA, talk to your doctor. A rheumatologist will be able to determine whether you have Heberden’s nodes or a different type of growth. They will also be able to work with you to find the best way of managing this symptom.
Heberden’s nodes are bony outgrowths that occur on the joints nearest to the fingertips. The nodes often make the hands look crooked or knotty. The affected joint may be painful and stiff, but the node itself may or may not be painful to the touch. Ligaments and other soft tissues can occasionally be involved in Heberden’s nodes, too.
Herberden's Nodes | Image courtesy of DermNet
Heberden’s nodes are similar to another type of bony growths known as Bouchard’s nodes. However, Bouchard’s nodes occur on the middle finger joints rather than those closest to the fingernail. Bouchard’s nodes are also significantly less common than Heberden’s nodes.
Heberden’s nodes are most often associated with moderate to severe osteoarthritis, rather than rheumatoid arthritis.
However, researchers have found that rheumatoid arthritis can affect the same joints as osteoarthritis, including the joints found nearest to the tip of the finger. When this happens, RA can produce changes in the joint that cannot be distinguished from Heberden’s nodes.
A person can have osteoarthritis and rheumatoid arthritis at the same time, which can make diagnosing the cause of Heberden’s nodes more complicated. In fact, many myRAteam members report having osteoarthritis alongside RA. One member in particular shared that along with a diagnosis of rheumatoid arthritis, they have erosive osteoarthritis, Bouchard's nodes, and Heberden's nodes.
Heberden’s nodes do not necessarily indicate the presence of osteoarthritis, either. While they are a strong indication that a person has osteoarthritis, a person should have other symptoms of osteoarthritis in addition to the nodes before being diagnosed with the condition.
Some people diagnosed with RA develop rheumatoid nodules. While rheumatoid nodules can occur anywhere on the body, they are most common on hands and elbows, as well as near the joints. If you develop a rheumatoid nodule near the end joint of one of your fingers, it can be easy to mistake them for Heberden's nodes. However, there are a few key differences that can help you distinguish between the two.
While rheumatoid nodules may be firm, they will not have the same bony feel as Heberden's nodes. They may feel more like a cyst or like a swollen lymph node. Even when they are hard, you will almost always be able to press them in a bit. You cannot do that with bony growths.
Rheumatoid nodules are usually not embedded into the tissue underneath them, so you can usually move them around under your skin. They can attach or become embedded in the underlying tissue, but they will usually still slide side to side a bit when pressed on. Bony Heberden's nodes will not do that.
Most Heberden’s nodes are small, appearing no larger than a pea under the skin right next to the affected joints. Rheumatoid nodules can be this small, but they can also become as large as a lemon.
Finally, Heberden’s nodes only occur on the joints closest to the ends of the fingers. If you have nodes anywhere else on your hands, they are not Heberden’s nodes and will be diagnosed as something else — possibly but not necessarily rheumatoid nodules. They could be cysts, infections, or the result of other conditions. Because of the diverse possible causes, it is important to talk to your rheumatologist as soon as you notice any new growths near or on your joints.
Read more about rheumatoid nodules.
The best way to determine whether you have Heberden’s nodes is to work with your doctor to image your hands. Most doctors will choose to use an X-ray because it is easy and minimally invasive. An expert will examine your X-rays or other images to determine whether or not your growths are Heberden’s nodes. They will also examine the abnormalities on your fingers to determine why they are there.
Afterward, your medical team will work to determine the cause of the nodes. Your physician will conduct a thorough physical exam and ask you questions that will help them determine whether you should be diagnosed with osteoarthritis, rheumatoid arthritis, or both. Your doctor may also order blood tests. If you have certain blood markers for rheumatoid arthritis, then it is more likely to be the right diagnosis for you.
After your doctor understands your symptoms and your medical history and they see the results of your tests, they should be able to give you the correct diagnosis.
The best way to manage Heberden’s nodes is to treat the underlying condition. Since the cause is most commonly osteoarthritis, treatment may involve osteoarthritis treatments such as physical therapy, medication, or even surgery.
If the correct diagnosis for your condition is rheumatoid arthritis, you have a variety of treatment options. These include various forms of medication, including:
You may also need surgery to address any joint damage that has occurred.
If you’re looking for support from people who understand what it means to live with rheumatoid arthritis every day, reach out at myRAteam — the social network for people diagnosed with rheumatoid arthritis and their loved ones. Here, more than 150,000 members from across the world come together to ask questions, offer support and advice, and share stories of life with RA.
Do you have symptoms of Heberden’s nodes or rheumatoid nodules? Share your experience in the comments below or by posting on myRAteam.