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 different sites or generalised disease.


METHODS
This was a population-based study of 660 middle ages 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 joint (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 (K 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, PID OA, and OA in more than two groups of joint (knee, CMC, and DIP joints).


CONCLUSIONS
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.
Department of Epidemiology and Preventive Medicine, Monash University Medical School, Alfred Hospital, Prahran, Australia.
F M
FM
Cicuttini
J
J
Baker
D J
DJ
Hart
T D
TD
Spector
D005260:Female; D005384:Finger Joint / Q000000981:diagnostic imaging* / Q000473:pathology; D006801:Humans; D008875:Middle Aged; D010003:Osteoarthritis / Q000000981:diagnostic imaging* / Q000473:pathology; D011237:Predictive Value of Tests; D011859:Radiography; D012218:Rheumatoid Nodule / Q000000981:diagnostic imaging*; D012680:Sensitivity and Specificity; D014955:Wrist Joint / Q000000981:diagnostic imaging / Q000473:pathology