Concise reports
Relation between Heberden's nodes and distal interphalangeal
joint osteophytes and their role as markers of generalised disease
a Department of Epidemiology and Preventive
Medicine, Monash University Medical School, Alfred Hospital, Prahran,
Victoria 3181, Australia, b The Twin
Research and Genetic Epidemiology Unit, St Thomas's Hospital, Guys'
and St Thomas's Trust, London
Correspondence to: Dr F Cicuttini.
Accepted for publication 19
February 1998
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.
METHODSThis 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.
RESULTSPoor agreement was observed between a
Heberden's node (HN) and a radiological distal interphalangeal
osteophyte in the same finger of the same hand (
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).
CONCLUSIONHN 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.
© 1998 by Annals of the Rheumatic Diseases
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