Heberden’s nodes are hard, bony bumps that develop on the joints closest to the tips of the fingers. They are typically associated with osteoarthritis, a form of arthritis that causes joint wear and tear over time. Rheumatoid nodules may look similar to Heberden’s nodes, but they’re linked to rheumatoid arthritis (RA).

Since both Heberden’s nodes and rheumatoid nodules appear near the joints and can look alike, they’re sometimes confused — especially when trying to tell the difference between osteoarthritis and RA. In this article, we’ll explore the key differences between the two and explain how each relates to its specific type of arthritis.

If you develop any unusual lumps or bumps around your joints, talk with your healthcare provider. A rheumatologist can help determine whether you’re seeing Heberden’s nodes, rheumatoid nodules, or something else, and they can help guide you toward the right treatment plan.

What Are Heberden’s Nodes?

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 near the affected joint can occasionally be involved in Heberden’s nodes, too.

Heberden’s nodes occur when the cartilage between the affected joints has worn down (called cartilage degeneration) and the bones of the joint have begun rubbing together directly.

In addition to these nodes, you may experience other signs of joint damage, like:

• Loss or decreased range of motion
• Stiffness and weakness in your hands where the nodes are

What Can Be Mistaken for Heberden’s Nodes?

Heberden’s nodes are similar to another type of bony growth 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 less common than Heberden’s nodes.

What Are Rheumatoid Nodules?

Rheumatoid nodules are firm lumps that grow under the skin. They are the most common skin-related symptom of RA.

What Do Rheumatoid Nodules Look Like?

Rheumatoid nodules are firm, flesh-colored lumps that typically form just under the skin. They’re usually round and made up of inflammatory tissue.

These nodules appear in an estimated 25 percent to 40 percent of people living with rheumatoid arthritis, most often in those with seropositive RA — meaning they test positive for rheumatoid factor (RF) or anti-cyclic citrullinated peptide (anti-CCP) antibodies.

The nodules don’t usually cause pain or tenderness, but they will feel firm to the touch. These nodules may become infected or inflamed (swollen) and ulcers (open sores) sometimes develop on them. In these cases, they may feel painful.

Rheumatoid nodules usually develop in areas where the body experiences repeated pressure — especially over joints. While they can appear in various parts of the body, they most commonly affect the:

• Fingers
• Elbows
• Forearms
• Heels
• Sacrum (the lower back near the tailbone)
• Hips

In some cases, nodules may also develop in places away from the joints, including the lungs, eyes, and even the vocal cords.

In rare cases, a person taking methotrexate for RA may develop accelerated nodulosis, a condition where nodules form and grow quickly, most often on the fingers or hands. Stopping methotrexate or adding another treatment may help the nodules shrink or go away.

Always talk to your doctor before stopping or changing any medication.

Heberden’s Nodes vs. Rheumatoid Nodules: 7 Key Differences

If you develop a rheumatoid nodule near the end joint of one of your fingers, it can be easy to mistake it for a Heberden’s node. However, there are a few key differences that can help you distinguish between the two.

1. Heberden’s Nodes Feel Bony

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.

2. Heberden’s Nodes Won’t Move When Touched

Rheumatoid nodules are usually not embedded into the tissue underneath them, so you can usually move them around slightly under your skin. They can attach or become embedded in the underlying tissue, but they will usually still slide from side to side a bit when pressed on. Bony Heberden’s nodes will not do that.

3. Heberden’s Nodes Are Smaller Than Rheumatoid Nodules

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.

4. Heberden’s Nodes Grow Only on the Fingertips

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. They may be rheumatoid nodules but could also be cysts, infections, or another condition. Because of the diverse possible causes, it’s important to talk to your rheumatologist as soon as you notice any new growths near or on your joints.

5. Heberden’s Nodes Are Usually a Sign of Osteoarthritis

Heberden’s nodes are most often associated with moderate to severe osteoarthritis rather than rheumatoid arthritis.

However, researchers have found that rheumatoid arthritis can occasionally 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 easily 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. Some 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.

6. Rheumatoid Nodule Diagnosis Usually Requires a History of RA

When a healthcare provider is examining and diagnosing rheumatoid nodules, they will ask if you have a history of RA. Since rheumatoid nodules aren’t usually one of the first symptoms of RA, people usually know they have RA before they get rheumatoid nodules.

Other autoimmune conditions may cause very similar-looking nodules, such as systemic lupus erythematosus (the most common form of lupus) and ankylosing spondylitis. When making a diagnosis, your healthcare provider will rule out other similar nodules and conditions.

7. Treatment Depends on the Underlying Cause

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, lifestyle changes, medication, and possibly surgery.

If the correct diagnosis for your condition is rheumatoid arthritis, you have a variety of treatment options. You may need surgery to address any joint damage that has occurred.

Rheumatoid nodules don’t always require treatment. If they cause symptoms like ulcers or pain or become infected, a healthcare provider may suggest a corticosteroid injection or surgery. The underlying RA should also be treated to prevent joint deformities and other complications.

There’s a Similar Diagnosis Process for Heberden’s Nodes and Rheumatoid Nodules

The best way to determine whether you have Heberden’s nodes or rheumatoid nodules is to work with your doctor to examine and image your hands. Most doctors will choose to use an X-ray because it is easy and minimally invasive. A health expert will examine your X-rays or other images to determine whether your growths are Heberden’s nodes, rheumatoid nodules, or something else.

Your medical team will then work to determine the cause of the nodes. Your healthcare provider will conduct a thorough physical exam and ask you questions to help them determine if you have osteoarthritis, rheumatoid arthritis, both, or another type of arthritis. Your doctor may also order blood tests. If you have certain blood markers for rheumatoid arthritis, it’s more likely that you have RA.

Talk With Others Who Understand

On myRAteam, the social network for people with rheumatoid arthritis, members come together to ask questions, give advice, and share their stories with others who understand life with RA.

Do you have Heberden’s nodes or rheumatoid nodules with RA? What was your diagnosis process like? Share your experience and tips in the comments below or by posting on your Activities page.