Distal finger joints involvement is usually seen with primary generalized OA.
The presence of hand osteoarthritis (OA) increases the risk for developing OA in other major joints. Although genetic predisposition has been implicated in its causation, its exact role has yet to be established. There was a significant correlation between severe hand OA and hip, knee, and spine involvement. Severity of Hand OA can have a predictive value on multiple joint involvement and risk of surgical intervention.
J Arthroplasty. 2016 Aug;31(8):1693-7.
Primary OA that come with age and wear and tear apparently are worse in weight bearing joints. So when finger joints are so degenerated to cause deformity and show typical radiological features, it could portend a positive predictive value for the major joints involvement and their severity,
Hand OA with the presence of Heberden's and Bouchard's nodes often indicates familial erosive inflammatory OA, with erosive changes on hand films. This condition is autosomal dominant in females, and autosomal recessive in males. Usually, the patient's mother has had the disease although the disorder can skip an entire generation, i.e., the patient's grandmother had it, but not necessarily the patient's mother. I agree with above that patients with hand OA are at risk of developing OA in the larger, weight-bearing joints,
Heberden's and Buchard's nodes around the distal finger joints are benign. They cause some inconvenience, motion restyriction and cosmetic defect but they are not a reliable sign for the severity of OA. They have a low imflammatory activity.
I agree; however, in many cases there is significant local (not systemic) inflammation, and even central erosions visible on x-rays of those DIP involved joints, not to mention the cosmetic problems that you mentioned,
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