We present the case of a 40-year-old male with no other personal or family history of interest who consulted with a 3-year history of nodules of a soft consistency on the dorsal surface of the proximal interphalangeal joints (PIPJ) of both hands (Fig. 1). He reported no pain or restricted mobility; physical examination did not reveal synovitis. Our attention was drawn to a proximal interphalangeal joint flexion contracture of the fifth finger of the right hand (Fig. 1). The dermatology department was consulted, and the clinical suspicion of Garrod pads was confirmed. We decided not to prescribe any treatment because these are asymptomatic lesions.

Fig. 1.

Painless nodules of a soft consistency on the back of the proximal interphalangeal joints of the hand, termed Garrod pads (black arrows). In addition to the Garrod pads a proximal interphalangeal joint flexion contracture of the fifth finger can be seen, known as camptodactyly (white arrow). When this association presents, associated genetic syndromes should be ruled out. Likewise, we should remember that camptodactyly has been described associated with arthritis and constrictive pericarditis.

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Knuckle or Garrod pads are a type of digital fibromatosis characterised as asymptomatic papular or nodular lesions seated on the dorsal surface of the PIPJ or, less often, the metacarpophalangeal joints.1–4 Since they can be confused with synovitis, it is important for the rheumatologist to be aware of them.1,4 Their aetiology is usually idiopathic or relating to repeated trauma.1,3 They can be hereditary, and associated with autosomal dominant hereditary diseases such as Peyronie's disease, Bart–Pumphrey syndrome or Dupuytren's disease.1,3 Likewise, such as the patient in this study, Garrod pads have been described in combination with camptodactyly (flexion contracture of a finger, usually the fifth digit).4–7 When this association presents, associated genetic syndromes should be discounted.5–8 We would also highlight that camptodactyly has been described associated with arthritis and constrictive pericarditis.8 Although diagnosis is usually clinical, histological study will reveal epidermal hyperplasia with hyperkeratosis, fibroblastic proliferation, and absence of inflammatory infiltrate.1,3 With regard to treatment, given the benign nature of the condition, many authors advocate therapeutic abstention.1 Nevertheless, in some cases topical glucocorticoids and keratolytic agents have been used, and even surgical removal.1,3

The authors have no conflict of interests to declare.