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I notice I'm getting what look like little cushions over the backs of my knuckles. It's not every knuckle but these are some on both hands. I don't have any pain or stiffness, so I don't think it's arthritis. What causes this?

You may be describing something that has been referred to by hand surgeons as knuckle pads. There is quite a bit of debate about these skin lesions. Some experts think they are the same as what others call nodules. What's the difference? Knuckle pads are soft areas of thickening with loss of skin elasticity over and around them. Nodules are firm or even hard and feel like knots. In either case, the lesions are painless and may be caused by separate things. Knuckle pads like the kind you have may be more likely a result of trauma or reaction to repetitive hand movements linked with work or occupation. These pads may also develop after injury to the tendon as the soft tissues try to repair themselves. Nodules are more often linked with specific hand diseases such as rheumatoid arthritis, osteoarthritis, and Dupuytren's disease. It's also possible that either of these skin changes may be an early sign of a more serious systemic disorder. The best thing to do is have your physician take a look at them. You may only be creating a baseline (what they look like now) for comparison later should there be any changes that develop. But an initial "look-see" to rule out a treatable condition is always a good idea.

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