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    What are they anyway?  Maybe some kind of new little snack foods?  No,
not unless you are fond of knuckle sandwiches!  Sorry, I must be feeling a
little punch drunk.  Oops, sorry again.
    Heberden's nodes are little paired knots on the last knuckles, generally
on the first 3 fingers.  They may be painful or painless, and are referred
to as symptoms of osteoarthritis, not rheumatoid arthritis.  I first read
about them in VITAMIN B6, THE DOCTOR'S REPORT by Ellis and Presley, 1973.
Dr. Ellis found them responsive to vitamin B6, and also felt that there was
a link to heart disease.
    As usual, I am here to ask you all a question.  Do you or other known or
suspected celiac members of your family have these knots on their fingers?
You can answer me directly and I will summarize.
     I am a massage therapist and thus meet people in chronic pain.  As a
result of my investigations into causes of chronic pain and "Fibrolyalgia",
my husband was diagnosed with hemochromatosis (HH) and I am self diagnosed
with celiac.  I find that the symptom lists for celiac disease and
hemochromatosis are practically identical.  They both cause fatigue,
arthritis, higher rates of cancer, esp colon cancer, both can even make
brown marks on the face.  Both are associated with heart disease, strokes,
diabetes.  I am forever looking for clues to tell them apart.  I think this
may be one, or it may just be a genetic thing that runs in families.  But
this is for your education too, so here goes....
    Recently I had a massage client in for just half an hour.  She is 44
years old, has Heberdon's nodes, and her hands hurt so much last winter that
she is nearly ready to go on pain medicine, only the high cost of Celebrex
is stopping her.  Her grandmother's hands were frozen into claws in her old
age, and before her father's accidental death at age 57, he was also having
quite a lot of arthritis pain.  She was having some problems that her doctor
considered early perimenopause, and has been on hormones these last 4 years
that have stopped her from having periods at all.  The Heberdon's nodes have
been present nearly that long. I did not get any other clues from her,
except that she wakes up each morning dead tired.  When she would donate
blood years ago, her Hgb and Hct were always borderline, which implies
celiac, but doesn't
necessarily mean she doesn't have HH.  The appearance of the nodes after
suppression of her periods concern me, and I recommended she have her serum
iron tested to see if it is too high (hemochromatosis) or too low, a clue to
look into celiac disease.
    Yesterday I did massages on a 75 year old woman with Heberdens' nodes,
which had hurt when they first appeared decades ago, but don't hurt anymore.
Her 46 year old daughter is developing them too, right about perimenopause
time.  There is some family history suggestive of celiac, but I wonder about
hemochromatosis too.

    Quotes from the book on B6:  "
1:  Particularly in women... near the age of menopause, the finger joints
became very painful."
2:  "Heberdon's nodes appear to be a part of periarthritis of the finger
joints affecting women near the age of menopause.   ...Pyridoxine(B6) was
most effective in the early treatment of periarthritis of the
interphalangeal joints and the accompanying Heberdon's nodes, a condition
known as menopausal arthritis.
3:  Early in my work during the 60's I saw 2 classical patients who were
nearing menopause and had been troubled for several months by these very
bright red, distinctly circumscribed nodes on the finger joints.  In both
cases the pain subsided and the redness disappeared within 5 weeks after
(B6) therapy began.  In the initial stages, then, Heberdon's nodes related
to hormone changes could be treated successfully.  In later stages there was
less certainty, although the patient usually did benefit in other ways.
4:  After 2 weeks of pyridoxine (50 mg orally a day) .... she was almost
free of pain in her fingers and hands.  (pt 47 years old)

As usual, I look forward to your answers, and if any of you do try the B6 or
iodine, I
would love to hear any results.  Which reminds me, one more quote:
5:  I hasten to emphasize that two disorders of the joints have not
responded to B6 in my experience: traumatic arthritis, caused by injury, and
rheumatoid arthritis.  Rheumatoid arthritis has a different etiology that is
unrelated to B6.

"Rheumatoid arthritis" is a common misdiagnosis for hemochromatosis, though
true RA is probably often related to celiac disease.
    B6 tends to be deficient in celiacs.  Magnesium seems to drop in the
menopausal years, and Mg is synergistic with B6, so if either one is low the
other can't be used properly for some capacities.  So I may find that this
is a celiac symptom rather than a HH symptom, or like so many other
symptoms, I may find that it is common to both groups.  Dr. Ellis was
convinced that Heberden's nodes had something to do with a hormonal problem
near menopause.  I myself developed fibrocystic breast pain at about 43
years old, and found it responded to iodine, which I am convinced is
malabsorbed by celiacs.  I note that many of the women I meet who have
celiac symptoms also have breast pain.(I have to ask usually for that one).
I know someone who carries Atomadine, the brand of iodine I use, and says a
number of women have ended their breast pain using it.  My grandmother who I
am convinced had celiac, had cysts in her breasts a couple of times with
associated big cancer scares as they didn't have ultrasound in those days.
Iodine is needed to break down estrogen properly, and if unavailable, excess
iodine can "irritate" the breast tissue.  We've all heard about Dr. Lee's
work and the notion that during perimenopause that estrogen may be too high,
and at any rate, is not balanced with progesterone.  These are all things to
look into if any of you suffer from Heberdon's nodes or fibrocystic breasts.

Now, from here I will go into subjects only of interest if you or friends or
family have arthritis. Not everything is caused by celiac disease, so you
should keep in mind that though hemochromatosis is only about 1/5 as common
as celiac disease, it's still 1 in 200 with the double genes, and it is far
easier to test for and treat than celiac.  What's more, the serum iron test
can do double duty to look for celiac.  I have seen test results from a
couple of people who got tested due to my urging, and their serum iron was
shockingly low.  A serum test plus B12/folate is really quite a decent way
to look for celiac.

DIP means "Distal interphalangeal" meaning the furthest finger joints from
the middle of the body.  This is where the paired knots called Heberden's
nodes appear. Here are two sites with illustrations:
A drawing:
http://www.orthop.washington.edu/arthritis/types/osteoarthritis/02.
A photo:  http://becker.wustl.edu/casestudy/cs1page1target4.htm.
MP joints are metacarpal-phalangeal,  the joints supposedly involved in
hemachromatosis where the hands meet the fingers.  They have good drawings
here of what happens in MP joint arthritis.
http://www.celebrationhealth.com/handcenter/arthritis_mpjoint.htm.
PIP means "proximal interphangeal" meaning the middle joints of the fingers,
which don't seem relevant.

A lot of medical language uses terms like proximal to distal, medial to
lateral, cephaled to caudal.  It means you don't have to have the person in
front of you to figure out which way is up according to how they are
standing or lying.  You may find it useful someday to know this.

Here is a site with a photo of MP joint arthritis that will shock you.  And
the real question is, has this person been tested for Hemochromatosis?  I
suspect they have not.
http://www.dynomed.com/encyclopedia/encyclopedia/arthritis/Arthritis_of_the_
Hand.html.
A quote from this site:
"Patients with ulnar drift of the fingers at the MP joint are often fitted
with a special splint.  Wearing the splint can slow the deformation process
but not prevent it from occurring."
This starts to look like chronic muscle contraction and trigger point
development in the back of the forearm, which to me implies the same in the
front of the forearm.  Trigger points develop in response to chronic muscle
tension, and perpetuate it.  You can control the trigger points and maybe
some symptoms with massage, but the underlying cause needs to be found.

http://wheeless.orthoweb.be/ooa1/113.htm.  This site says:
"approximately 40% of pts w/ RA will have intrinsic contracture;
     - in some cases the intrinsic contracture will result from MP joint
dislocation, and in other cases, the intrinsic contracture will be
idiopathic and may result in MP dislocation as the intrinsic tightness
progresses (as determined by Bunnel test).   Either MP subluxation will
occur or the constant pull of the intrinsics will cause a swan neck
deformity beginning at the PIP joint"

    In other words, the muscles will tighten if you have a dislocation of
the joint, but if the muscles are chronically tight, they will slowly
dislocate the joints.  "Idiopathic" means basically that we idiots don't
know what is causing it.
    The "intrinsic" muscles of the hand are those actually within the hand,
which is not exactly what I expected.  Travell's book MYOFASCIAL PAIN AND
DYSFUNCTION says the intrinsics cause Heberdon's nodes, but I don't believe
they get into MP joint problems at all.  Guess I need to get my hands on a
copy of the new improved version of Vol 1, merely a $95 investment, LOL.  I
also need to get my hands on some new HH patients and see how their hands
and arms feel to me.  My husband's muscles feel much more relaxed to me now
that he has been deironed.

I have seen the swan neck deformity on hands of a typical lupus victim, a
disease that causes lax joints and is often linked to celiac disease.  Don't
know if there is any relationship to HH, I  think HH joints and muscles
become tighter, not looser, so probably people with HH will get the MP joint
dislocation rather than the swan neck deformity.  Celiac IS considered by
many to be involved in lupus.

What I have to wonder is whether Heberdon's nodes will prove celiac related,
so that we can look at arthritic hands and see whether the person has celiac
or HH.  So many symptoms of celiac are similar to those of HH that I wind up
advising people to get their iron tested, and look into celiac if it is low.
It would be nice to have a few distinguishing characteristics.
Donna

* Visit the Celiac Web Page at www.enabling.org/ia/celiac/index.html *