Bouchard’s Nodes: Causes and Treatments

Bouchard's nodes are bony enlargements of the middle joints of the fingers, also known as proximal interphalangeal (PIP) joints. These are the finger joints closest to the knuckles.

The nodes are a classic sign of osteoarthritis, or joint degeneration, of the hand. They were named after the French pathologist Charles-Joseph Bouchard who studied people with arthritis during the 19th century.

Bouchard's nodes are less common than Heberden's nodes, which are bony enlargements of the distal interphalangeal (DIP) joints closest to the fingertips.

This article discusses the symptoms and causes of Bouchard's nodes and explains how the condition is diagnosed and treated.

What Are the Symptoms of Bouchard’s Nodes?

Bouchard's nodes, like Heberden's nodes, may or may not be painful. However, they will typically affect the extent to which a joint can move or its range of motion.

Over time, this accumulation of excess bone tissue can cause the following symptoms:

• Misaligned bones causing crooked fingers
• Swollen fingers
• Weakened grip, making it difficult to do daily tasks like opening a jar, using a can opener, or turning a key

What Causes 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 cause of Bouchard's nodes is the same as any other manifestation of osteoarthritis: the long-term wear and tear of joint tissues.

Osteoarthritis most often affects the joints of the hands, knees, hips, lower back, and neck. With this very common condition, the tissues that normally cushion the joint space are worn away. Joint damage and inflammation can lead to excessive remodeling of bone tissue. Ossification—the part of the process responsible for bone formation—can cause nodules to form.

Risk Factors

Risk factors for Bouchard's nodes are the same as the risk factors for osteoarthritis, which include:

• Older age
• Being female
• Obesity
• Smoking (females only)

Osteoarthritis is also more common in white people than Black and Hispanic people.

How Are Bouchard’s Nodes Diagnosed?

A Bouchard's node is considered a characteristic sign of osteoarthritis, helping differentiate it from other types of arthritis such as gout or rheumatoid arthritis.

With that said, there are also bumps associated with rheumatoid arthritis and gout. People with rheumatoid arthritis may develop rubbery bumps on the thumb and knuckles called rheumatoid nodules. People with gout may develop crystallized lumps in the joint space called tophi.

Since there are no blood tests to diagnose osteoarthritis, your healthcare provider may perform other tests to rule out rheumatoid arthritis and gout as causes.

These include:

• Blood tests to check for rheumatoid factor (RF) and anti-cyclic citrullinated peptide (CCP) antibodies, which are seen in rheumatoid arthritis
• Blood uric acid, which is elevated with gout
• Uric acid crystals in joint fluid, which is associated with gout

A complete blood count (CBC) can be used to measure the white blood cell count (WBC). Because osteoarthritis is not associated with chronic inflammation, WBCs will usually be normal or near-normal, whereas they are often elevated with gout and rheumatoid arthritis, which are inflammatory conditions.

Imaging tests, such as an X-ray to check for joint cartilage loss, can also help confirm the diagnosis.

How Are Bouchard’s Nodes Treated?

Although you can't get rid of Bouchard's nodes, you can treat the pain associated with them. The bump itself won't go away unless you have surgery to remove it, but surgical removal is uncommon.

The treatment for Bouchard's nodes is similar to the treatment approach for hand osteoarthritis without nodes.

This includes:

• Resting the joint
• Heat and ice therapy
• Pain relievers like Tylenol (acetaminophen) or nonsteroidal anti-inflammatory drugs (NSAIDs) like Aleve (naproxen) or Advil (ibuprofen)
  
• Topical capsaicin cream, lidocaine, or NSAIDs (like Voltaren gel) for minor aches and pain
• Injections of steroids into the joint for severe cases
  

Joint immobilization may also be used during acute flare-ups to minimize joint movement.

Therapy may be needed to improve joint mobility and prevent disability:

• Physical therapy can help improve hand movement.
• Occupational therapy can help improve your ability to perform certain activities of daily living.

Surgery is rarely used for treating Bouchard's nodes—mainly only for cosmetic reasons.

Summary

Bouchard's nodes are bony overgrowths of the middle joints of the fingers caused by osteoarthritis. They occur when the loss of joint cartilage and inflammation cause excessive bone formation. Bouchard's nodes may or may not contribute to pain, but typically cause joint stiffness, grip weakness, and misaligned, crooked fingers in severe cases.

The diagnosis involves lab and imaging tests that help differentiate osteoarthritis from similar conditions like gout and rheumatoid arthritis.

Bouchard's nodes can be treated with rest, ice or heat therapy, pain relievers, or steroid injections if there is pain. Hand therapy can help prevent disability and increase joint mobility.