Heberden's Nodes

HEBERDEN'S NODES (Heberden), enlargements of the terminal interphalangeal joints of the fingers, described as a distinct chronic condition in 1802 by Heberden. Subsequently, H. n. were considered by some authors as a manifestation of gout, and by others as a special form of osteoarthritis. H. n. develop between the ages of 40 and 60, predominantly in women. They are localized symmetrically on the terminal interphalangeal joints of the V and IV fingers; the III and II fingers are affected less frequently, while the thumb is affected extremely rarely. The process develops insidiously; patients experience numbness and stiffness in the fingers, pain is rarely observed. Heberden himself considered the absence of pain to be typical. Over time, the nodes increase in size, and ankylosis forms in the affected joints. On X-ray, osteophytes and rarefaction of bone tissue are visible in the centers of the phalanges adjacent to the affected joints. The basis of the disease lies in degenerative changes in the cartilage and hyperplastic processes in the bone tissue (formation of osteophytes). The etiology is unknown. Heredity plays a significant role. Observations by Pfeiffer support the connection between H. n. and gout. H. n. do not respond to treatment.