Eight patients with bronchogenic carcinoma presented with painful joint effusions as part of the syndrome of hypertrophic osteoarthropathy. Elevated sedimentation rates and symptomatic relief with aspirin were common, but synovial fluids all had leukocyte counts less than 500/mm3. Synovial microvascular injury was found in all patients, and electron-dense deposits in synovial vessel walls were identified in 5 cases. These vascular deposits suggest a role for circulating materials in pathogenesis.Painful swelling around knees, ankles, wrists, and occasionally fingers may be the presenting manifestation of hypertrophic pulmonary osteoarthropathy (HPO) but can easily be mistaken clinically for rheumatoid arthritis (1,2). Clubbing may be subtle but is rarely absent. Because HPO may be an important early clue to the diagnosis of bronchogenic carcinoma and other pulmonary mass lesions, this report describes 8 cases and emphasizes some characteristics of the arthropathy that should help raise the possibility of a diagnosis of HPO.
~_ _ _ _From the Veterans Administration Hospital and the University of Pennsylvania.