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Omission of Hypertrophic Osteoarthropathy Delays the Early Diagnosis of a Lung Neoplasm. ARS MEDICA TOMITANA 2022. [DOI: 10.2478/arsm-2020-0038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Abstract
Introduction. Hypertrophic osteoarthropathy (HOA) is a syndrome characterized by periostitis of the long (tubular) bones, clubbing of the digits and arthritis. Less than 4,5% of the lung cancer patients developed hypertrophic osteoarthropathy as a paraneoplastic manifestation.
Case presentation. We present a case of a 59 year old man, smoker presents for 18 months recurrent symmetric arthritis of knee. He lost 6 kilograms and he had no pulmonary symptoms. Physical examination revealed digital clubbing with watch-glass nails painless of all fingers, joint effusion of the knees. Laboratory results revealed only inflammatory syndrome and anaemia of chronic disease. The X-rays revealed periosteal appositions at the tibia, fibula and femur, mass in the left lower lobe. Computed tomography confirmed lung tumor and biopsy showed the malignant character of the tumor.
Conclusion. The index of suspicion for OAH should be high in a patient with symmetrical arthritis who associates Hippocratic fingers.
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Primary hypertrophic osteoarthropathy - a rare cause of pain and arthritis in children. Description of 5 cases. Cent Eur J Immunol 2022; 47:280-287. [PMID: 36817261 PMCID: PMC9896987 DOI: 10.5114/ceji.2022.120171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2021] [Accepted: 07/13/2022] [Indexed: 11/17/2022] Open
Abstract
Primary hypertrophic osteoarthropathy (PHOA) is a very rare disease. The typical triad of symptoms, i.e. digital clubbing, periosteal bone formation with bone and joint deformities and skin hypertrophy, may be accompanied by other specific conditions. In the majority of patients, the picture of the disease is incomplete. The dominant clinical symptom may be osteoarticular complaints. Moreover, the final confirmation of the diagnosis of the primary form of hypertrophic osteoarthropathy requires the analysis of much more frequent secondary causes of the disease. Diagnosing primary osteoarthropathy in children is particularly difficult. Some children report joint pain before the onset of the other symptoms of osteoarthropathy, while the physical and imaging examinations show features of arthritis. This can lead to misdiagnoses including the diagnosis of juvenile idiopathic arthritis (JIA) and the unnecessary use of immunosuppressive treatment. The present description of five patients from the Paediatric Rheumatology Department indicates diagnostic difficulties in children with PHOA. All of them were examined due to pain and features of arthritis. We observed an incomplete clinical picture of the disease. One patient required a revision of the previous diagnosis of JIA and discontinuation of ineffective treatment with disease-modifying antirheumatic drugs (DMARDs). PHOA should always be considered in the differential diagnosis of arthritis in children, due to the slow and often atypical development of symptoms, including the presence of pain and arthritis as the predominant symptom of the disease.
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Woicke J, Al-Haddawi MM, Bienvenu JG, Caverly Rae JM, Chanut FJ, Colman K, Cullen JM, Davis W, Fukuda R, Huisinga M, Walker UJ, Kai K, Kovi RC, Macri NP, Marxfeld HA, Nikula KJ, Pardo ID, Rosol TJ, Sharma AK, Singh BP, Tamura K, Thibodeau MS, Vezzali E, Vidal JD, Meseck EK. International Harmonization of Nomenclature and Diagnostic Criteria (INHAND): Nonproliferative and Proliferative Lesions of the Dog. Toxicol Pathol 2021; 49:5-109. [PMID: 33393871 DOI: 10.1177/0192623320968181] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
The INHAND (International Harmonization of Nomenclature and Diagnostic Criteria for Lesions) Project (www.toxpath.org/inhand.asp) is a joint initiative of the societies of toxicologic Pathology from Europe (ESTP), Great Britain (BSTP), Japan (JSTP), and North America (STP) to develop an internationally accepted nomenclature for proliferative and nonproliferative lesions in laboratory animals. The purpose of this publication is to provide a standardized nomenclature for classifying lesions observed in most tissues and organs from the dog used in nonclinical safety studies. Some of the lesions are illustrated by color photomicrographs. The standardized nomenclature presented in this document is also available electronically on the internet (http://www.goreni.org/). Sources of material included histopathology databases from government, academia, and industrial laboratories throughout the world. Content includes spontaneous lesions, lesions induced by exposure to test materials, and relevant infectious and parasitic lesions. A widely accepted and utilized international harmonization of nomenclature for lesions in laboratory animals will provide a common language among regulatory and scientific research organizations in different countries and increase and enrich international exchanges of information among toxicologists and pathologists.
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Affiliation(s)
| | | | | | | | | | - Karyn Colman
- Genomics Institute for the Novartis Research Foundation, La Jolla, CA, USA
| | - John M Cullen
- North Carolina State University College of Veterinary Medicine, Raleigh, NC, USA
| | | | - Ryo Fukuda
- Axcelead Drug Discovery Partners, Inc, Fujisawa, Kanagawa, Japan
| | | | | | - Kiyonori Kai
- Daiichi Sankyo Co, Ltd, Medical Safety Research Laboratories, Edogawa-ku, Tokyo, Japan
| | - Ramesh C Kovi
- Experimental Pathology Laboratories (EPL), Inc, Research Triangle Park, NC, USA.,National Toxicology Program (NTP), US National Institute of Environmental Health Sciences (NIEHS), Research Triangle Park, NC, USA
| | | | | | | | | | - Thomas J Rosol
- Ohio University Heritage College of Osteopathic Medicine, Athens, OH, USA
| | | | | | - Kazutoshi Tamura
- Pathology Department, BoZo Research Center Inc, Shizuoka, Gotemba, Japan
| | | | | | | | - Emily K Meseck
- Novartis Pharmaceutical Corporation, East Hanover, NJ, USA
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Kiely PDW, Lloyd ME. Ankle arthritis - an important signpost in rheumatologic practice. Rheumatology (Oxford) 2021; 60:23-33. [PMID: 33097958 PMCID: PMC7785314 DOI: 10.1093/rheumatology/keaa531] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Revised: 07/21/2020] [Accepted: 07/24/2020] [Indexed: 12/17/2022] Open
Abstract
Ankle arthritis is a useful clinical signpost to differential diagnosis in rheumatic disease. Biomechanical features and differences in cartilage physiology compared with the knee may confer protection of the ankle joint from factors predisposing to certain arthritides. The prevalence of ankle OA is low, and usually secondary to trauma. Primary OA of the ankle should be investigated for underlying causes, especially haemochromatosis. New presentations of inflammatory mono/oligo arthritis involving the ankle are more likely due to undifferentiated arthritis or spondyloarthritis than RA, and gout over CPPD. The ankle is often involved in bacterial and viral causes of septic arthritis, especially bacterial, chikungunya and HIV infection, but rarely tuberculosis. Periarticular hind foot swelling can be confused with ankle arthritis, exemplified by Lofgren’s syndrome and hypertrophic osteoarthropathy where swelling is due to subcutaneous oedema and osteitis respectively, and the ankle joint is rarely involved.
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Affiliation(s)
- Patrick D W Kiely
- Department of Rheumatology, St George's University Hospitals NHS Foundation Trust.,Institute of Medical and Biomedical Education, St George's University of London, London
| | - Mark E Lloyd
- Department of Rheumatology, Frimley Health NHS Foundation Trust, Frimley, UK
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A 49-Year-Old Man With Cough and Hand, Wrist, and Knee Pain. Chest 2020; 157:e47-e51. [PMID: 32033661 DOI: 10.1016/j.chest.2019.09.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Revised: 08/12/2019] [Accepted: 09/05/2019] [Indexed: 11/23/2022] Open
Abstract
CASE PRESENTATION A 49-year-old man was sent by his primary care physician to the rheumatology clinic with complaints of several months of bilateral lower extremity swelling. The swelling migrated from both ankles up to his knees. Presenting symptoms consisted of bilateral knee pain as well as bilateral wrist and hand pain with swelling. Pulmonary symptoms consisted of a nagging productive cough of several months. He also complained of significant weight loss: 50 pounds over 12 months. He was a never smoker. The examination was notable for bilateral knee effusions. Radiographs of his wrists, hands, and knee were obtained, along with a chest radiograph. He was then referred to a pulmonologist for further workup.
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Ulutaş F, Ulu M, Karasu U, Çobankara V. Hypertrophic Osteoarthropathy Presenting as Rheumatoid Arthritis Mimicker: A Case Report. Cureus 2020; 12:e9271. [PMID: 32699730 PMCID: PMC7372233 DOI: 10.7759/cureus.9271] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Paraneoplastic rheumatologic syndromes are defined as clinical conditions that mimic primary rheumatic disease in the course of cancer; they generally improve with the effective treatment of underlying malignancy. Hypertrophic osteoarthropathy (HOA) is one of the paraneoplastic syndromes, and it is characterized by the combined presence of periostosis, digital clubbing, and swelling of soft tissues, skin, and joints in the distal extremities. HOA is commonly associated with intrathoracic malignancies (primary lung tumors or metastases). In this report, we discuss a patient with HOA secondary to lung adenocarcinoma, who was admitted with symmetric polyarthritis presenting as elderly onset rheumatoid arthritis. He was successfully treated with chemotherapy ablation for underlying malignancy. Anti-inflammatory drugs were also administered. HOA should be kept in mind in the differential diagnosis of inflammatory arthritis.
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Affiliation(s)
| | - Meral Ulu
- Internal Medicine, Pamukkale University, Denizli, TUR
| | - Uğur Karasu
- Rheumatology, Pamukkale University, Denizli, TUR
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