Hypertrophic Osteoarthropathy

Clubbing and hypertrophic osteoarthropathy occur with a variety of lung tumors, mesothelioma and occasionally with other tumors such as hepatomas. The musculoskeletal problems can be great mimics. A However in contrast to most RA the knees and ankles are involved early, there is often prominent periarticular tenderness on careful examination and the synovial effusion if aspirated has low leukocyte counts. Clubbing may not be prominent early and in some cases the characteristic periosteal elevation is not seen on initial xrays. Bone scans can then be used as a sensitive test to detect periostitis. If unexplained hypertrophic osteoarthropathy is detected a search should always be made for malignancy although benign diseases such as ulcerative colitis, lung abscess, cyanotic heart disease and a familial form also can cause the clubbing and arthropathy. Mechanisms of the vessels walls. These have not been identified but do not appear to be immunoglobulins. circulating tumor derived products would be one possible cause. Treatment of hypertrophic osteoarthropathy is mostly symptomatic. NSAIDS are often helpful. One should attempt cure of accessible tumors as tumor removal can relieve the osteoarthropathy symptoms but long term survival from tumors causing osteoarthropathy is disappointing rare.