Hypertrophic osteoarthropathy and rheumatoid arthritis. Simultaneous occurrence in association with diffuse interstitial fibrosis

Abstract

A patient is described who was treated with highdose prednisone in an attempt to halt progressive respiratory insufficiency associated with diffuse interstitial fibrosis. On cessation of steroid therapy the patient was noted to have radiologic manifestations of hypertrophic osteoarthropathy (HOA) as well as clinical and laboratory features of rheumatoid arthritis (RA). Subsequently a diffuse vasculitis developed with bowel perforation and sepsis leading to death.The association of digital clubbing with several pulmonary diseases, including diffuse interstitial fibrosis (DIF), is well established (1). Similarly pulmonary disease, especially bronchogenic carcinoma, has been asso-