As defined by marie in 1890, it is a symmetrical osteitis of the four limbs, chiefly localized to. Hypertrophic osteoarthropathy hoa is a syndrome that consists of periostitis, digital clubbing, and painful polyarthropathy. Long and coworkers reported hypertrophic pulmonary osteoarthropathy hpoa in a 5yearold american saddlebred. We describe a case of 23yearold man, who presented with painful hypertrophic pulmonary osteoarthropathy involving bilateral upper and lower extremities, resulting from intrathoracic metastasis. The distribution of extremity blood flow before and after. Thick, solid, wavy periosteal reaction is noted adjacent to the distal femurs bilaterally. Baumrucker, md, faafp, faahpm, ahmed alsheyyab, md, and. It is mainly characterized by pachydermia thickening of the skin, periostosis excessive bone formation and finger clubbing swelling of tissue with loss of normal angle between nail and nail bed. 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. These patients, when taken with other lines of evidence, provide further support for an estrogenic role in the cause of hypertrophic osteoarthropathy. Review on hypertrophic osteoarthropathy and clubbing.
Hypertrophic osteoarthropathy manifests as digital clubbing, subperiosteal new bone formation in. Hypertrophic pulmonary osteoarthropathy hpo is a sub. Hypertrophic pulmonary osteoarthropathy hpoa lung cancer. Hypertrophic osteoarthropathy ho is a disorder characterized by changes to the skin and bones, and occurs either in a rare familial primary form primary hypertrophic osteoarthropathy, pho, also called pachydermoperiostosis pdp, with a 9. Hypertrophic osteoarthropathy is an osteopetrosis variant that occurs secondary to other disease processes, including chronic obstructive pulmonary disease, lung cancer,308 bronchiectasis, pulmonary fibrosis, congenital heart disease, liver cirrhosis, cystic fibrosis,309 chronic gastrointestinal disease, renal tubular acidosis,310 cystic fibrosis, multiple. Radiologically there are two patterns, one characterized by new bone formation which predominates in patients with pulmonary disease, and another by acroosteolysis that is most frequently associated with congenital heart disease. Hypertrophic pulmonary osteoarthropathy causes regional periosteal reaction, particularly in the long bones. The complete hypertrophic osteoarthropathy syndrome includes clubbing of the fingers and toes, periostitis with new bone formation on long bones, and arthritis. Treatment of painful hypertrophic osteoarthropathy associated with nonsmall cell lung cancer with octreotide. Know the types, causes, symptoms, pathophysiology and treatment of. The purpose of this paper is to report three cases of pulmonary osteoarthropathy secondary to pulmonary metastases from extra. Jan 08, 2018 hypertrophic osteoarthropathy hoa is a syndrome of clubbing of the digits, periostitis of the long tubular bones, and arthritis. 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 osteoarthropathy hypertrophic pulmonary osteoarthropathy hypertrophic osteoarthropathy is a disorder characterized by bilateral symmetrical subperiosteal new bone formation at the ends of long bones. Eleven had joint involvement six hypertrophic pulmonary osteoarthropathy hpoa, one cf arthropathy, two ciprofloxacin induced arthralgia, one joint contracture following long. Incidence of hypertrophic pulmonary osteoarthropathy. The musculoskeletal complications of cystic fibrosis. Hpoa is a group of symptoms that can affect the organs, lungs, bones and joints. Acquired clubbing of the digits and hypertrophic osteoarthropathy are closely related disorders of unknown etiology that derive special significance from their frequent association with. The primary change in the limbs of patients with pulmonary hypertrophic osteoarthropathy is an overgrowth of vascular connective tissue investing the structures in the.
Hypertrophic pulmonary osteoarthropathy with primary lung. Hoa can be easily missed in patients with disseminated cancer, preexisting lung disease, and bone pain. Hoa can also be associated with pleural, mediastinal, and cardiovascular causes, as well as extrathoracic conditions such as gastrointestinal tumors and. Hypertrophic osteoarthropathy is a medical condition, which affects the joints and the bones of the body. Preoperatively, the distribution of microspheres to the extremity.
Pulmonary hypertrophic osteoarthropathy jama jama network. Pdf hypertrophic osteoarthropathy in association with. The clinical data of 6,151 patients with advanced lung. Pachydermoperiostosis pdp is a rare genetic disorder that affects both bones and skin. Pulmonary hypertrophic osteoarthropathy annals of internal.
Started in 1995, this collection now contains 6760 interlinked topic pages divided into a tree of 31 specialty books and 732 chapters. Hypertrophic pulmonary osteoarthropathy hpoa is a syndrome characterized by the triad of periostitis, digital clubbing and painful arthropathy of the large joints, especially involving the lower limbs. Lung cancer, clubbing and hypertrophic pulmonary osteoarthropathy. Hypertrophic osteoarthropathy probably shares the same mechanism, and is mainly attributable to pdgf release. A rare but treatable condition in palliative medicine mehdi pourmorteza, do, steven j. Hypertrophic osteoarthropathy is an osteopetrosis variant that occurs secondary to other disease processes, including copd, lung cancer,311 bronchiectasis, pulmonary fibrosis, congenital heart disease, liver cirrhosis, cystic fibrosis,312 chronic gi disease, renal tubular acidosis,3 multiple myeloma,314 and other chronic diseases.
This is the combination of clubbing and thickening of periosteum connective tissue lining of the bones and synovium lining of joints, and is often initially diagnosed as arthritis. This means that the extremities become enlarged, leading to the appearance of pain and inflammation specifically at the level of the joints. Hypertrophic osteoarthropathy hoa is a rare paraneoplastic syndrome characterized by digital clubbing, periosteal reaction, polyarthralgia, arthritis, and synovitis. Hypertrophic osteoarthropathy hpoa is a syndrome characterized by periosteal reaction of the long bones without underlying bone lesion. Hypertrophic osteoarthropathy metastases extrathoracic. The painful osteoarthropathy had made the patient incapacitated. In most cases it develops over a period of time and is essentially symptomless. Hypertrophic pulmonary osteoarthropathy and its occurrence. The association between digital clubbing and idiopathic pulmonary fibrosis has been well established.
Request pdf hypertrophic osteoarthropathy hypertrophic osteoarthropathy oah is defined by the presence of clubbing and periosteal proliferation of the tubular bones. A patient with hypertrophic pulmonary osteoarthropathy associated with adenocarcinoma of the left upper lobe was studied before and after suprahilar vagectomy by arm and lung scans following left brachial artery injection of labelled albumin microspheres, digital plethysmography and forearm arteriovenous oxygen differences. Full text get a printable copy pdf file of the complete article 1. Hypertrophic osteoarthropathy clinical presentation. Treatment with intravenous pamidronate was successful in. Hypertrophic pulmonary osteoarthropathy specifically refers to hypertrophic osteoarthropathy in the setting of a lung disease, and not from other intrathoracic processes such as mediastinal or pleural disease 5.
The management and prognosis of hoa is dependent on the underlying disease process. Distal expansion of the long bones as well as painful, swollen joints and synovial villous proliferation are often seen. Initial visits to doctors are usually for minor pains in the shoulders and hands. Hypertrophic pulmonary osteoarthropathy in four patients with. A distinction is to be made between simple clubbing of the fingers and osteoarthropathy. A questionnaire survey of 375 patients with cystic fibrosis was performed to seek evidence of pulmonary hypertrophic osteoarthropathy phoa.
Hypertrophic osteoarthropathy causes, diagnosis, treatment. Pitting edema and hypertrophic pulmonary osteoarthropathy. Dec 09, 2016 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. He was treated with nsaid for pain relief and referred to oncology department for further management. Hypertrophic osteoarthropathy hoa is a rare syndrome associated with digital clubbing, periostitis, and painful swollen joints. Marie, 1 in 1890, and bamberger, 2 in 1891, first described the syndrome that bears their name, more widely known as hypertrophic pulmonary osteoarthropathy. Pdf hypertrophic pulmonary osteoarthropathy hpoa or pierre marie bambergersyndrome is a paraneoplastic. Pulmonary hypertrophic osteoarthropathy definition of. Palliative care rounds hypertrophic pulmonary osteoarthropathy. Hypertrophic pulmonary osteoarthropathy hpo is a rare. Although the association of hypertrophic pulmonary osteoarthropathy hpo with lung cancer was investigated in the 1960s, the recent incidence of clinically apparent hpo is not known. Secondary hypertrophic osteoarthropathy caused by non. Hypertrophic pulmonary osteoarthropathy eds cancer, principles and practice of oncology.
Case report hypertrophic osteoarthropathy secondary to. Hypertrophic pulmonary osteoarthropathy hpoa hypertrophic pulmonary osteoarthropathy is a condition that affects some people with lung cancer. Hypertrophic pulmonary osteoarthropathy, or hypertrophic osteoarthropathy, received its name from pierre marie in 1890, but was first described by eugen bamberger in 1889. Clubbing in liver disease is associated with multiple small pulmonary arteriovenous anastomoses which allow large particles through. A special form of clubbing is hypertrophic pulmonary osteoarthropathy hpoa, known in continental europe as pierre mariebamberger syndrome. Hypertrophic osteoarthropathy an overview sciencedirect. Basically, the finger and toes suffer from a process that is known as clubbing.
Hypertrophic osteoarthropathy as a complication of. Hypertrophic osteoarthropathy in eisenmenger syndrome. Hypertrophic osteoarthropathy and digital clubbing dermnet nz. In three patients, bone scintigraphy was repeated postoperatively, and the hpo findings improved in two of them figure 1. Pdf hypertrophic pulmonary osteoarthropathy hpoa or pierre mariebambergersyndrome is a paraneoplastic. Evaluation of pulmonary hypertrophic osteoarthropathy in. There are a broad range of manifestations, although typically there is symmetrical involvement of the appendicular skeleton. Hypertrophic osteopathy occurs in human beings known as maries disease. Acquired clubbing of the digits and hypertrophic osteoarthropathy are closely related disorders of unknown etiology that derive special significance from their frequent association with serious underlying diseases of the thorax or abdomen. It is a rare syndrome, so there is not much information about it. Pharmacologic therapy with nonsteroidal antiinflammatory drugs was effective in relieving pain from hypertrophic osteoarthropathy hoa during his hospital stay and after 3 months of followup.
Since that time, medical literature has recorded divergent opinions regarding the incidence of this disorder in certain diseases and the relationship of simple digital clubbing to hypertrophic osteoarthropathy. It may be seen alone or as part of an entity called. Hypertrophic pulmonary osteoarthropathy hpoa pierre marie. Observations of radionuclide imaging in hypertrophic pulmonary osteoarthropathy. Treatment of hypertrophic osteoarthropathy in the case of. A 50yearold man presented with rightarm numbness and he was found to have a rightsided pancoast tumor. Hpoa without clubbing of the digits is considered an incomplete form of hpoa and has been rarely reported. Hypertrophic osteoarthropathy as a complication of pulmonary. 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. 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. Case report hypertrophic osteoarthropathy secondary to thymoma. The diagnosis of hypertrophic pulmonary osteoarthropathy hpo was made. Recognising and treating it accordingly will reduce the symptom burden of patients.
Bole a patient is described who was treated with high dose prednisone in an attempt to halt progressive respi ratory insufficiency associated with diffuse interstitial fibrosis. Although a rare idiopathic form of hypertrophic osteoarthropathy has been described, 5 chronic pulmonary disease has been the most frequent cause of osteoarthropathy. Circulating vascular endothelial growth factor concentrations in a case of pulmonary hypertrophic. Some periosteal reaction was noted adjacent to the proximal tibias and fibulas bilaterally.
Hypertrophic osteoarthropathy radiology reference article. This condition is characterized by symmetric periostitis involving the radius and fibula and, to a lesser extent, the femur, humerus, metacarpals, and metatarsals. Hypertrophic osteopathy has been known as hypertrophic pulmonary osteopathy, hypertrophic pulmonary osteoarthropathy, 26 and hypertrophic osteoarthropathy. Hypertrophic osteopathy has not only been found in humans and dogs but also in horses, cows, sheep, cats, fowl and other species of animals. Secondary hoa previously referred to as hypertrophic pulmonary osteoarthropathy is most commonly associated with primary lung malignancies, particularly nonsmall cell lung carcinoma. Paraneoplastic hypertrophic pulmonary osteoarthropathy and. The patient was diagnosed as having hypertrophic pulmonary osteoarthropathy hoa secondary to squamous cell carcinoma of the lung, presenting as arthritis. Hypertrophic pulmonary osteoarthropathy article about. The patient had a history of undifferentiated nasopharyngeal carcinoma which was treated successfully 2 years ago.
Hypertrophic pulmonary osteoarthropathy hpoa pierre. 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. The aetiology of clubbing and hypertrophic osteoarthropathy. Hypertrophic osteoarthropathy hoa is a syndrome characterized.
Hypertrophic pulmonary osteoarthropathy radiology case. Hypertrophic osteoarthropathy with acroosteolysis in a. Hypertrophic pulmonary osteoarthropathy an overview. Hypertrophic osteoarthropathy and pregnancy annals of. Hypertrophic pulmonary osteoarthropathy definition of. Hypertrophic pulmonary osteoarthropathy as a paraneoplastic. Hypertrophic osteoarthropathy hoa is a syndrome of clubbing of the digits, periostitis of the long tubular bones, and arthritis. What hypertrophic pulmonary osteoarthropathy hpoa is. Treatment of hypertrophic osteoarthropathy with underlying pulmonary adenocarcinoma using zoledronic acid. Hypertrophic pulmonary osteoarthropathy is a common clinical entity presenting with.
It has also been referred to as hypertrophic pulmonary osteoarthropathy because the underlying disease has most often been found to be pulmonary in nature. Hypertrophic pulmonary osteoarthropathy in association with pulmonary metastases from extrathoracic tumours. The relationship between the site of the primary tumour and the incidence of pulmonary osteoarthropathy has not been described before. Data from a large series of patients with lung cancer were analysed, in order to assess the incidence of possible hpo, based on bone. Primary hypertrophic osteoarthropathy is a rare inherited condition. Hypertrophic pulmonary osteoarthropathy with primary lung cancer. We present a case of a patient diagnosed with nonsmall cell lung cancer and hoa suffering from. Pulmonary hypertrophic osteoarthropathy jama internal. Hypertrophic osteoarthropathy can be defined as a medical condition in which the bones and the joints are affected. 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. Hypertrophic osteopathy in dogs symptoms, causes, diagnosis. Hypertrophic pulmonary osteoarthropathy hpoa is a syndrome characterized by the. Hypertrophic osteoarthropathy is a medical condition combining clubbing and periostitis of the small hand joints, especially the distal interphalangeal joints and the metacarpophalangeal joints.
The most prevalent secondary causes of hoa are pulmonary in origin, which is why this condition was formerly referred to as hypertrophic pulmonary osteoarthropathy. Herein, we report a case series of patients with secondary hoa caused by nonpleural or pulmonary tumors. Distal expansion of the long bones as well as painful, swollen joints. Hypertrophic pulmonary osteoarthropathy hpo is a rare paraneoplastic syndrome that is frequently associated with lung cancer. Hypertrophic pulmonary osteoarthropathy affects bones, joints, and soft tissues and can. Hypertrophic pulmonary osteoarthropathy secondary to bronchial. Most commonly but not exclusively, the condition is associated with destructive chronic lung disease or lung tumors.
A case is reported of hypertrophic osteoarthropathy as the presenting feature of pulmonary metastases from renal carcinoma, and of its relief by pulmonary resection. Hypertrophic osteoarthropathy hoa is a pathological condition. A case of hypertrophic pulmonary osteoarthropathy hpoa in a hivinfected patient with. Painful hypertrophic osteoarthropathy successfully treated. The other patient had the onset of clubbing with her first pregnancy, and the symptoms of hypertrophic osteoarthropathy recurred with each of four subsequent pregnancies. It is most commonly seen in patients with lung cancer, but may also be associated with other intrathoracic tumors or nonmalignant diseases, such as hepatopulmonary syndrome of advanced liver disease cirrhosis and cyanotic heart diseases. 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. A 44yearold man presented with painful swelling of wrists and ankles, severe pain at both tibiae, clubbing of fingers and toes and arthritis in. Hypertrophic osteoarthropathy is a syndrome characterized by proliferation of skin and bone in the distal extremities. S ir, hypertrophic pulmonary osteoarthropathy hpoa is a syndrome defined by digital clubbing and distal periostitis in tubular bones. Hypertrophic osteoarthropathy is an entity characterized by a triad of periostitis of long bones, clubbing and arthritis. In coexistent lung cancer with pulmonary tuberculosis.