Jan 23, 20 digital clubbing, which has been recognized as a sign of systemic disease, is one of the most ancient diseases. Hayder saeed and suleiman massarweh of the university of kentucky share with us the story and images of a woman presenting with weight loss and cough, and discovered to have hypertrophic pulmonary osteoarthropathy, velvety palmar skin, clubbing. Hypertrophic pulmonary osteoarthropathy hpoa hypertrophic pulmonary osteoarthropathy is a condition that affects some people with lung cancer. We present a case of a patient diagnosed with nonsmall cell lung cancer and hoa suffering from. A distinction is to be made between simple clubbing of the fingers and osteoarthropathy. Dec 02, 2015 hypertrophic osteoarthropathy hoa is a clinical syndrome of clubbing of the fingers and toes, enlargement of the extremities, and painful, swollen joints. Both proved to have primary lung tumours with hypertrophic pulmonary osteoarthropathy, in one case resolving promptly with treatment of the.
Hypertrophic osteoarthropathy an overview sciencedirect topics. The exact pathogenic mechanism is unknown, but periosteal vascularity is reduced. Hypertrophic osteoarthropathy mimicking a reactive arthritis. A 77yearold man presented with fever, diarrhea, and an. Hoa is characterized by clubbed fingers, periostitis of long bones and arthritic changes 1. Introduction although digital clubbing was described by hippocrates, 1 and in 200 ad the relationship of clubbing to chronic diseases was noted, 2 it was not until the end of the 19th century that the clinical entity of hypertrophic osteoarthropathy was presented as a clinical and pathological syndrome by marie, 3 in 1890, and bamberger, 4 in 1891. Hypertrophic osteoarthropathy cancer therapy advisor. Hpoa is a group of symptoms that can affect the organs, lungs, bones and joints. In hypertrophic osteoarthropathy, the toes and fingers go through a process which is termed as clubbing, where there is enlargement of the extremities resulting in inflammation and pain, especially at the joint level. The paradox that clubbing of the fingers usually occurs with pulmonary hypertrophic osteoarthropathy, though most instances of clubbed fingers are not associated with osteoarthropathy, should halt those physicians who have adopted the grandiose but misleading habit of referring to clubbing of the fingers as pulmonary hypertrophic osteoarthropathy.
Hypertrophic osteopathy is a diffuse periosteal proliferative condition of long bones in dogs secondary to neoplastic or infectious masses in the thoracic or abdominal cavity. Pulmonary hypertrophic osteoarthropathy pho is a syndrome of unknown etiology, presenting with osteitis of the long bones, arthritis, and clubbing of digits, associated with lung cancer or other. Hypertrophic pulmonary osteoarthropathy without clubbing of the digits. Jun 17, 2011 this is a power point about primary hypertrophic osteoarthropathy hpoa go to. Hypertrophic osteoarthropathy hoa is a syndrome characterized. Hypertrophic pulmonary osteoarthropathy is a paraneoplastic syndrome seen in patients with lung cancer. It is a rare syndrome, so there is not much information about it. Recognising and treating it accordingly will reduce the symptom burden of patients. Hypertrophic pulmonary osteoarthropathy journal of pain and. Although the etiology remains speculative, unilateral vagotomy on. The patient was diagnosed as having hypertrophic pulmonary osteoarthropathy hoa secondary to squamous cell carcinoma of the lung, presenting as arthritis. The diagnosis of hypertrophic pulmonary osteoarthropathy hpo was made. A 44yearold man presented with painful swelling of wrists and ankles, severe pain at both tibiae, clubbing of fingers and toes and arthritis in. It has also been referred to as hypertrophic pulmonary osteoarthropathy because the underlying disease has most often been found to be pulmonary in nature.
Pdf hypertrophic osteoarthropathy hoa is characterized by. Hypertrophic osteoarthropathy the journal of the american. This clinical triad of digital clubbing, arthralgias, and ossifying periostitis has been recognized since the late 1800s and was previously known as hypertrophic pulmonary osteoarthropathy hpoa. Hypertrophic osteoarthropathy can be defined as a medical condition in which the bones and the joints are affected. Hypertrophic osteopathy occurs in human beings known as maries disease. Clinical signs include lameness, longbone pain, and signs secondary to body cavity.
Secondary hypertrophic osteoarthropathy is associated with many illnesses. Hypertrophic pulmonary osteoarthropathy definition of. The primary change in the limbs of patients with pulmonary hypertrophic osteoarthropathy is an overgrowth of vascular connective tissue investing the structures in the distal part of the limb. This means that the extremities become enlarged, leading to the appearance of pain and inflammation specifically at the level of the joints. Pulmonary hypertrophic osteoarthropathy definition of. He was treated with nsaid for pain relief and referred to oncology department for further management.
Hypertrophic osteoarthropathy is a relatively common syndrome of marked diagnostic significance 14 yet infrequently recognized. Hypertrophic pulmonary osteoarthropathy eds cancer, principles and practice of oncology. What hypertrophic pulmonary osteoarthropathy hpoa is. Jan 29, 2020 in the primary form, the periostitis is usually not painful. It is important in that it is often an early manifestation of an occult disease, frequently a malignancy, still in a curable stage. A case of secondary hypertrophic osteoarthropathy associated with uncomplicated congenital heart disease of the fallot type is presented, together with a roentgenologic study and with illustrations showing the gross physical deformities, electrocardiographic records, and xray findings. Hpoa without clubbing of the digits is considered an incomplete form of hpoa and has been rarely reported. Hypertrophic osteoarthropathy causes, diagnosis, treatment. Treatment with intravenous pamidronate was successful in. Hypertrophic osteoarthropathy hoa is a medical condition characterized by abnormal proliferation of skin and periosteal tissues involving the extremities and characterized by three clinical features.
All structured data from the file and property namespaces is available under the. This condition is characterized by symmetric periostitis involving the radius and fibula and, to a lesser extent, the femur, humerus, metacarpals, and metatarsals. The study of a clinically indistinguishable idiopathic form primary hypertrophic osteoarthropathy, pho provides an opportunity to understand the pathogenesis of hypertrophic. Pulmonary hypertrophic osteoarthropathy annals of internal.
The management and prognosis of hoa is dependent on the underlying disease process. Hypertrophic osteoarthropathy is largely considered a secondary phenomenon, and nearly always 9597% of cases occurs in the setting of a wide variety of other cardiopulmonary, gastrointestinal, endocrine, hematologic, and inflammatory conditions 5. Basically, the finger and toes suffer from a process that is known as clubbing. Hypertrophic osteopathy in dogs symptoms, causes, diagnosis. We report the case of a 30yearold man diagnosed with primary pulmonary hypertension for two years, developing hypertrophic osteoarthropathy with a mixed. Hypertrophic osteopathy in small animals musculoskeletal. Primary hypertrophic osteoarthropathy is a rare condition. Hypertrophic osteoarthropathy is a medical condition combining clubbing and periostitis of the small hand joints, especially the distal interphalangeal joints and the metacarpophalangeal joints. This condition is characterized by the presence of digital. May 14, 2018 hypertrophic osteoarthropathy hoa is a syndrome characterized by abnormal proliferation of skin and periosteal tissues of the extremities. Pulmonary hypertrophic osteoarthropathy jama jama network.
Hypertrophic pulmonary osteoarthropathy an overview. The disease is characterized by progressive, often bilateral, periosteal, new bone formation in the diaphyseal and metaphyseal regions, particularly of the distal limbs, that occurs as a secondary. Lung cancer, clubbing and hypertrophic pulmonary osteoarthropathy. Effective symptomatic relief of hypertrophic pulmonary. Example sentence with the word osteoarthropathy azdictionary. Hypertrophic pulmonary osteoarthropathy with tripe palms. Know the types, causes, symptoms, pathophysiology and treatment of.
The most prevalent secondary causes of hoa are pulmonary in origin, which is why this condition was formerly referred to as hypertrophic pulmonary osteoarthropathy. Distal expansion of the long bones as well as painful, swollen joints and synovial villous proliferation are often seen. When associated with cancer, it is considered a paraneoplastic syndrome. The idiopathic form named pachydermoperiostosis, primary hypertrophic osteoarthropathy or tourainesoulentegole syndrome is a rare disease, with unknown etiology, and represents 3 to 5% of all cases of hypertrophic osteoarthropathy. Paraneoplastic hypertrophic pulmonary osteoarthropathy and. Hypertrophic pulmonary osteoarthropathy and its occurrence. Syndrome characterized by abnormal proliferation of skin and osseous tissues at distal parts of the extremities causing clubbing andor boney pain due to periostosis. Here, we report an unusual clinical presentation of hoa. Full text get a printable copy pdf file of the complete article 1. Various modalities for the treatment of hypertrophic pulmonary osteoarthropathy hpoa associated with lung cancer have been suggested since 1958.
Hypertrophic osteopathy has been known as hypertrophic pulmonary osteopathy, hypertrophic pulmonary osteoarthropathy, 26 and hypertrophic osteoarthropathy. In a patient with chronic lung disease, the findings are in keeping with hypertrophic osteoarthropathy, and would explain the patients chronic pain. Hpo is an arthropathy that results from a pulmonary. However, the pathogenesis of clubbing and hypertrophic osteoarthropathy has hitherto been poorly understood. Pdf clubbed fingers and hypertrophic osteoarthropathy in a. Hypertrophic pulmonary osteoarthropathy secondary to bronchial.
Secondary hoa previously referred to as hypertrophic pulmonary osteoarthropathy is most commonly associated with primary lung malignancies, particularly nonsmall cell lung carcinoma. Hypertrophic osteoarthropathy is a medical condition, which affects the joints and the bones of the body. Jan 08, 2018 hypertrophic osteoarthropathy hoa is a syndrome of clubbing of the digits, periostitis of the long tubular bones, and arthritis. Hypertrophic osteoarthropathy with acroosteolysis in a patient with. Hypertrophic osteoarthropathy hoa is a clinical syndrome of clubbing of the fingers and toes, enlargement of the extremities, and painful, swollen joints. Hypertrophic pulmonary osteoarthropathy article about. Hypertrophic osteopathy has not only been found in humans and dogs but also in horses, cows, sheep, cats, fowl and other species of animals. Hypertrophic pulmonary osteoarthropathy hpoa is a syndrome characterized by the triad of periostitis, digital. Hypertrophic osteoarthropathy hoa is a syndrome that consists of periostitis, digital clubbing, and painful polyarthropathy.261 190 24 1416 1174 539 1256 58 1128 1120 450 42 1237 1487 1057 272 453 192 667 311 1299 396 1226 190 1263 896 1215 827