Heberden osteoarthritis
| Classification according to ICD-10 | |
|---|---|
| M15.1 | Heberden's lump (with arthropathy) |
| ICD-10 online (WHO version 2019) | |
The Heberden's node , named after the London doctor William Heberden (1710-1801) is an idiopathic osteoarthritis of the distal interphalangeal joints ( distal interphalangeal , DIP) with formation of Heberden nodes . The disease is mainly genetic, but also hormonal. Overloading of the hands or fingers - for example due to work or extreme sporting activity - that lead to a loosening of the capsular ligament apparatus can also contribute to the triggering of polyarthrosis. In addition, family factors come into question.
Clinical picture
The Heberden knots are characteristic . These are two-humped, cartilaginous-bony growths on the extensor side of the base of the distal phalanges. They are often accompanied by significant local inflammatory and destructive symptoms: joint plump and deviation to the thumb side , pain, loss of strength, restricted mobility.
For the first time , these knot-shaped swellings on the end joints of the fingers were delimited by Heberden in 1901 from the nodules ( tophi ) that occur in gout .
Heberden's osteoarthritis often affects the end joints of the index finger and little finger . The median joints of the fingers ( proximal interphalangeal joints , PIP; Bouchard osteoarthritis ) - also known as Heberden-Bouchard osteoarthritis - and the thumb saddle joint (→ rhizarthrosis ) are also often affected. If other joints or the spine are also affected, one speaks of polyarthrosis . The disease can appear in phases and - even at rest - be very painful. An episode can last for months.
Epidemiology
Heberden's osteoarthritis affects women about ten times more often than men. The disease usually begins during menopause . It is estimated that 190 out of 100,000 women between the ages of 50 and 59 develop hand osteoarthritis each year, and only 27 out of 100,000 men of the same age group are affected.
diagnosis
It is a so-called eye diagnosis. The presence of Heberden's lumps is characteristic; other tests are usually not necessary other than an X-ray . A skeletal scintigraphy is usually made before a possible radiosynoviorthesis .
Heberden's osteoarthritis must be distinguished from chronic polyarthritis in the differential diagnosis. In addition to the clinical picture and the x-ray of the hands, certain blood tests and possibly a three-phase skeletal scintigram may be necessary in rare cases . Other differential diagnoses are the gout - arthropathy and psoriatic arthritis .
therapy
Painkillers ( analgesics ), cortisone injections into the joint, surgical procedures (especially joint stiffening, arthrodesis ) and radiosynoviorthesis are used for therapy. In addition, physiotherapy , occupational therapy , physical therapy (especially cold application) and X-ray stimulus radiation are used. Finger exercises are recommended: Through targeted and regular movement exercises, the articular cartilage can be adequately supplied with nutrients, thus preventing the disease from progressing. However, warmth is only recommended as long as there is no inflammation.
Individual evidence
- ↑ Attila Dunky, Rudolf Eberl: Gout and hyperuricemia. G. Braun, Karlsruhe 1981 (= Rheuma-Forum. Volume 11), ISBN 3-7650-1632-2 , p. 12.
- ↑ Nikolaus Wülker: Pocket textbook on orthopedics and trauma surgery . Georg Thieme Verlag, January 2010, ISBN 978-3-13-129972-7 , p. 413–.
- ↑ Henning Zeidler , Beat A. Michel: Differential diagnosis of rheumatic diseases . Springer Science & Business Media, December 3, 2008, ISBN 978-3-540-76773-2 , pp. 415-.
- ↑ Birgitta Waldner-Nilsson: Hand Rehabilitation . Springer Science & Business Media, 2009, ISBN 978-3-540-23548-4 , pp. 252-.
