University of Pennsylvania, Philadelphia, PA, USA
Correspondence to: G. E. Ehrlich. E-mail: g2e{at}mindspring.com
SIR, The concurrence of haemochromatosis with interphalangeal osteoarthritis (OA) and rheumatoid arthritis (RA) [1] is indeed unusual, but RA in the context of interphalangeal OA is not. In a series of 170 patients who had interphalangeal, usually erosive, OA, 26 (15.3%) later developed RA [2]. All had previously had symmetrical involvement of distal (DIP) and proximal (PIP) interphalangeal joints and to a lesser extent of other hand joints. The superimposition of RA suggested Pfropfarthrose [3], an engrafting that the highly inflammatory OA presaged.
As Crain [4] has already noted, however, Bouchard's nodes might be a misnomer, as what Bouchard described [5] were PIP nodes in young patients, with flexion deformities, as a consequence, he surmised, of gastric dilatation', thus not what today are given the eponym.
The author has declared no conflicts of interest.
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