CONCISE REPORTS Relation between Heberden’s nodes and distal interphalangeal joint osteophytes and their role as markers of generalised disease

Objective—Heberden’s nodes are often used as a marker for osteoarthritis (OA). This study examined how often Heberden’s nodes and radiological distal interphalangeal (DIP) osteophytes coexist in the same digit and the sensitivity, specificity, and positive predicative value of each for OA at diVerent sites or generalised disease. Methods—This was a population-based study of 660 middle aged women taking part in a twin study of OA. Distal interphalangeal osteophytes were defined radiologically and graded on a four point scale (0–3) using a published atlas of individual features. Heberden’s nodes were defined by standardised clinical examination. OA in other joints (knees, proximal interphalangeal (PIP) joints and carpometacarpal (CMC) joints) was defined radiologically using a published atlas. Results—Poor agreement was observed between a Heberden’s node (HN) and a radiological distal interphalangeal osteophyte in the same finger of the same hand (ê statistic (95% CI) = 0.36 (0.33, 0.39)). Although HN and radiological DIP osteophytes had similar sensitivity, the specificity and positive predicative value of DIP osteophytes was considerably higher for detecting knee, CMC, PIP OA, and OA in more than two groups of joints (knee, CMC, and DIP joints). Conclusion—HN are not synonymous with DIP osteophytes. Radiological DIP osteophytes are a better marker of knee and multiple joint OA than HN. HN may still be an imperfect surrogate for hand OA when radiology is impractical, but are not an accurate marker of generalised disease. (Ann Rheum Dis 1998;57:246–248) The presence of clinically detected Heberden’s nodes (HN) is often used as a marker of osteoarthritis (OA). 2 Minimal information is available on the biological relation between HN and distal interphalangeal joint (DIP) osteophytes. Most workers have tended to look at one or the other and not both and there has been the underlying assumption that they are one and the same thing. However, the histology of HN remains unclear and a variety of pathologies have been described. Some workers have described the findings of bony outgrowths associated with classic features of OA in the cartilage, 4 while others have observed hypertrophic cartilage. In other instances, mucoid transformation of the periarticular fibroadipose tissue associated with proliferation of myxoid fibroblasts and cyst formation has been described. Recently it was suggested that clinical HN are inferior to radiological examination in predicting knee OA. We examined the role of HN and DIP as markers of knee OA and multiple joint involvement in OA in a population-based study of 660 middle aged women. Methods Participants were taking part in a twin study of OA that has previously been described. In brief, the study population consisted of female twins aged 48–69 years selected from two sources of volunteers: a normal twin register held in the Institute of Psychiatry, London and directly through an advertising campaign in the media. This population of middle aged women did not diVer in prevalence of OA or risk factors for OA (that is, age, weight, smoking, physical activity) from another populationbased sample of middle aged women previously described. The demographic features of the population were as follows: mean (SD) age 56.4 (6.8) years,mean (SD) weight 63.7 (10.9) kg; 47.2% past or current smokers; 89% postmenopausal; and mean (SD) age of menopause 48.9 (6.3) years. The analyses presented in table 1 refer to the DIP joints (6590) examined as separate units. Hand joints were examined in a systematic way using previously validated and reproducible techniques where anterior swellings were scored after training with an experienced observer. 10 HN were classified as: grade 0 = no bony swelling, grade 1 = definite bony swelling, not severe; grade 2 = severe bony swelling but no deformity; grade 3 = severe bony swelling. Methods for radiographic assessment have previously been described. DIP Ann Rheum Dis 1998;57:246–248 246 Department of Epidemiology and Preventive Medicine, Monash University Medical School, Alfred Hospital, Prahran, Victoria 3181, Australia