Hypertrophic Osteoarthropathy

Hypertrophic osteoarthropathy is classified as either primary (hereditary) or secondary. The primary form usually appears in children or young adults. The secondary form can occur at any age and is most often associated with neoplasms or infectious diseases. In the secondary form, associated diseases are more often intrathoracic than extrathoracic. Hypertrophic osteoarthropathy associated with infectious diseases is often characterized by an insidious development of mild rheumatic complaints over a period of months or years. In contrast, rapid onset and progression of hypertrophic osteoarthropathy with prominent joint pain is often associated with malignant diseases.

Hypertrophic osteoarthropathy (HOA) is a clinical syndrome of clubbing of the fingers and toes, enlargement of the extremities, and painful swollen joints Medical history included chronic obstructive pulmonary disease (emphysema), hypertension, cerebrovascular disease and multinodular goiter. Initial visits to doctors are usually for minor pains in the shoulders and hands Medical history included chronic obstructive pulmonary disease (emphysema), hypertension, cerebrovascular disease and multinodular goiter Diaphyseal expansion in tubular bones and sclerosis of the spongiosa in both appendicular and axial skeletal sites are evident. . Phyllodes tumours are fibroepithelial lesions arising from intralobular breast stroma. Secondary HOA is associated with an underlying pulmonary, cardiac, hepatic, or intestinal disease and often has a more rapid course it is more prevalent in the male; secondary type is a condition with symmetrical osteitis of the four limbs, chiefly localized to the phalanges and the terminal epiphyses of the long bones of the forearm and leg, sometimes extending to the proximal ends of the limbs and the flat bones, and accompanied by dorsal kyphosis and joint

Hypertrophic osteoarthropathy is a disease of the joints and bones . In most cases it develops over a period of time and is essentially symptomless. Initial visits to doctors are usually for minor pains in the shoulders and hands. The term HPOA emphasizes the pulmonary problems that represent a major cause of periostitis, although conditions other than pulmonary disorders may cause HPOA. HPOA is a syndrome in which clubbing of fingers and toes, arthritis, and epriostitis occur. Poorly defined bone outgrowths in the epiphyses of tubular bones and sometimes also in the axial skeleton are especially characteristic of this disease Surgical . About 20% of patients with phyllodes tumours develop distant metastases, and long-term survival in these women is rare. history included a right carotid endarterectomy.

Causes of Hypertrophic Osteoarthropathy

The common causes of Hypertrophic Osteoarthropathy :

• Crohn disease, ulcerative colitis, chronic infections, laxative abuse, polyposis, and malignant tumors
• case report in Germany described a family with a variant form of primary HOA restricted to the lower extremities without digital clubbing or cutaneous changes.
• Bacterial endocarditis
• The actual cause of hypertrophic osteoarthropathy remains unclear. Oestrogens, circulating factors, neurogenic factors and growth hormone are all thought to play a role.
• Cyanotic Congenital Heart Disease.

Symptoms of Hypertrophic Osteoarthropathy

Some are common symptoms of Hypertrophic Osteoarthropathy :

• Deep bone pain at distal extremities (usually legs)
• Bone thickening of wrists and ankles
• Swollen fists are present in all patients and that phenomenon is characteristic sign of the disease
• The aim of our work was to determine the occurrence of dermatological symptoms in patients with PDP and their relatives, and to study ultrastructural skin changes in the complete and incomplete forms of the disease.

Treatment of Hypertrophic Osteoarthropathy

Nonsteroidal antiinflammatory drugs (NSAIDs) have been beneficial in reducing discomfort, but not in reversing the condition. Aspirin in modest doses or another NSAID, particularly indomethacin, is frequently effective. A variety of agents that cause vasodilation may prove of value, such as calcium channel-blocking drugs. Analgesics are appropriate. Adrenocortical steroid derivatives can be useful . Radiotherapy to the primary tumor site or to the metastatic lesion, as well as chemotherapy, has relieved joint symptoms. Complete disappearance of hypertrophic osteoarthropathy is described after liver transplantation and after appropriate therapy for empyema, lung abscess, bronchiectasis, pneumonia, and bacterial endocarditis . Resolution of symptoms and signs has been shown to follow simple denervation of the hilum or vagotomy on the same side as the lesion. Thoracotomy without denervation in these studies was ineffective. The most importent of Hypertrophic Osteoarthropathy :

• In those with primary HOA, propranolol may be useful for the hyperhydrosis, but the drug does not alter the natural course of the disorder.
• The only effective treatment for secondary hypertrophic osteoarthropathy (HOA) is treatment of the underlying condition, ie, surgery for cardiac anomalies or cancer and antibiotics for infections.
• Nonsteroidal anti-inflammatory drugs may be helpful for relieving painful osteoarthropathy.
• Aspirin in modest doses or another NSAID, particularly indomethacin, is frequently effective.

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