Clinical features

The onset of nodal osteoarthritis can be sudden, with hot, inflamed distal interphalangeal (I.P.) joints. The hands are stiff and painful.

Inflammation may spread to the proximal interphalangeal joints and the carpometacarpal joints of the thumbs.

The initial severe inflammation subsides, forming firm nodal swellings over the interphalangeal joints:

• Heberden's nodes over the distal I.P. joints
• Bouchard's nodes over the proximal I.P. joints

End stage nodal osteoarthritis is characterised by:

• painless, bony swelling of the I.P. joints
• marked limitation in the range of movement
• occasional angulation deformities of the I.P. joints