Fact-sheet: Hypertrophic osteoarthropathy
Updated on 04/23/2019 at 9:44 AM
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Definition
Clinical and radiologic syndrome associating:
- periosteal appositions of the long bones of the upper and lower limbs, bilateral and symmetric
- arthralgias and intra-articular effusions
- digital clubbing
Secondary to a chronic thoracic, abdominal, or systemic disease, of benign or malignant origin.
Bronchopulmonary adenocarcinoma is the most common cause.
Clinical features
Digital clubbing
Joint involvement is the most common presenting manifestation of hypertrophic osteoarthropathy.
This consists of simple arthralgias with a mechanical or inflammatory pattern, more rarely a subacute oligoarthritis with inflammatory changes of the overlying soft tissues.
The most commonly affected joints are the knees and ankles.
Laboratory findings
Elevated ESR
Radiography
Diaphyseal, then metaphysodiaphyseal periosteal appositions: long bones +++, more rarely the extremities.
Hypertrophy or acro-osteolysis of the terminal phalangeal tufts
MRI
Active appositions
Nuclear medicine
Parallel bands of increased uptake along the diaphyses of the long bones, usually preceding the radiographic signs --> early diagnosis
Symmetric, linear increased uptake outside the cortex of the long bones;
Occasionally periarticular increased uptake.
Management
Etiologic treatment
Symptomatic treatment:
- NSAIDs
- corticosteroids
- bisphosphonates
Differential diagnosis
- diffuse or multifocal periosteal appositions
- chronic venous stasis disease
- fluorosis
- hypervitaminosis A
- treatment with prostaglandin E1, interleukin 1
- infantile cortical hyperostosis (Caffey disease)