Hypertrophic Osteoarthropathy: Clinical and Imaging Features

Abstract

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: digital clubbing (also termed Hippocratic fingers), periostosis of tubular bones, and synovial effusions. HOA can be a primary entity, known as pachydermoperiostosis, or can be secondary to extraskeletal conditions, with different prognoses and management implications for each. There is a high association between secondary HOA and malignancy, especially non-small cell lung cancer. In such cases, it can be considered a form of paraneoplastic syndrome. The most prevalent secondary causes of HOA are pulmonary in origin, which is why this condition was formerly referred to as hypertrophic pulmonary osteoarthropathy. HOA can also be associated with pleural, mediastinal, and cardiovascular causes, as well as extrathoracic conditions such as gastrointestinal tumors and infections, cirrhosis, and inflammatory bowel disease. Although the skeletal manifestations of HOA are most commonly detected with radiography, abnormalities can also be identified with other modalities such as computed tomography, magnetic resonance imaging, and bone scintigraphy. The authors summarize the pathogenesis, classification, causes, and symptoms and signs of HOA, including the genetics underlying the primary form (pachydermoperiostosis); describe key findings of HOA found at various imaging modalities, with examples of underlying causative conditions; and discuss features differentiating HOA from other causes of multifocal periostitis, such as thyroid acropachy, hypervitaminosis A, chronic venous insufficiency, voriconazole-induced periostitis, progressive diaphyseal dysplasia, and neoplastic causes such as lymphoma. RSNA, 2016.

Hypertrophic osteoarthropathy mimicking a reactive arthritis: a case report and review of the literature

“…Nevertheless, the patient’s age, his digital clubbing, and the lack of a good clinical response to steroid therapy led us to perform additional exams and finally to the diagnosis of HOA. Hypertrophic osteoartropathy, also known as Pierre Marie-Banberger syndrome, is a condition characterized by the triad of digital clubbing, periosteal reaction of long bones and painful tenderness of the limbs, especially in the lower extremities, sometimes with synovial non-inflammatory effusions of large joints [ 3 ]. When all three clinical features are simultaneously present, a complete form of HOA is diagnosed, but most often HOA presents as an incomplete form, with the possibility of digital clubbing being absent [ 6 ].…”

“…Owing to the high association between HOA and lung malignancies [ 3 ], the patient underwent a bronchoscopy with bronchoalveolar lavage (BAL) and transbronchial biopsies of the right lung infiltrate. Unfortunately, biopsies could not be performed because of the complexity in localizing the infiltrate under fluoroscopy.…”

Impact of hypertrophic pulmonary osteoarthropathy on patients with lung cancer

“…However, some researchers reported that abnormal production of hypoxia-induced agents, including platelet-derived growth factor (PDGF), prostaglandin E2 (PGE2), and vascular endothelial growth factor (VEGF) in patients with HPOA, was observed. 5 Therefore, subsequently, patients with primary familial hypertrophic osteoarthropathy and neonates with congenital heart disease were prescribed long-term PGE2 injections owing to the possibility of a biochemical pathway. 6 , 7 …”

Hypertrophic osteoarthropathy in a patient with known lung cancer

“…1 In HOA, the pattern of periostitis is bilaterally symmetrical, a pattern also demonstrated in venous stasis, pachydermoperiostosis and thyroid acropachy. Unilateral or localised periosteal reactions may occur secondary to trauma, neoplasm and infective and inflammatory conditions (eg, osteomyelitis, arthritis).…”