Heberden's node

Abstract: An 88-year-old woman was referred for acute arthritis of the fingers. Twelve days previously, she had experienced acute pain with swelling of the right 4th proximal interphalangeal joint (PIP). Several days later, she developed a lowgrade fever and pain of the 3rd distal interphalangeal joint (DIP). She had experienced a similar attack six months earlier that had resolved within a week. Her medical history included chronic heart failure due to aortic valve stenosis for 20 years, and chronic kidney disease. She was taking aspirin, candesartan, and furosemide. A physical examination showed tenderness, swelling and redness of the 3rd DIP and the 4th PIP joints, both of which included internal deposits and were superimposed on osteoarthritis (Picture 1). Hand radiography showed typical nodal osteoarthritis of DIP and PIP (Heberden’s and Bouchard’s nodes, respectively) associated with widening of the soft tissue shadows (Picture 2). Joint puncture revealed needle crystals (Picture 3). Gouty arthritis superimposed on nodal osteoarthritis is rare, and twothirds of cases are in women. Most have predisposing factors of hyperuricemia, including hypertension, renal impairment, and long-term diuretic use (1), as seen in our patient.

Abstract: Purpose We investigated the usefulness of a custom-made splint for treatment of painful osteoarthritis of the distal interphalangeal (DIP) joints. The splint was designed to be easily detachable so as not to diminish finger pad sensation or interfere with proximal interphalangeal joint motion. Methods We enrolled 25 patients (24 women and one man, mean age 58 y) with painful osteoarthritis of the DIP joints of the fingers and thumbs in this cohort study. Nineteen patients had multiple affected digits in one or both hands. Splints were applied to protect and immobilize the DIP joints. We assessed the outcome of this treatment using the visual analog scale pain score and the Quick Disabilities of the Arm, Shoulder, and Hand score for subjective assessment of symptoms. The mean follow-up period after wearing the splint until assessment was 6 months. Subjects were assessed 6 months after they started wearing the splint. Results Pain decreased from 100% at pretreatment to 34% at final follow up. So, the average improvement ratio was 66%. The Quick Disabilities of the Arm, Shoulder, and Hand disability/symptom score changes were not statistically significant (28 points pretreatment and 17 points at final follow-up). Conclusions This splint reduced pain from DIP osteoarthritis according to the visual analog scale; however, this does not enable the patient to obtain completely satisfactory function of the upper extremities. Type of study/level of evidence Therapeutic IV.