Hypertrophic osteoarthropathy in cystic fibrosis.

“…Nonetheless, there are some differences. HOA is relatively common in carcinoma of the bronchus (about 10% of cases [IOS]), and in some other lung conditions, such as cystic fibrosis [31,32]; yet it is manifestly much less common and much less florid in cyanotic congenital heart disease. One difference could be in megakaryocyte function.…”

Section: Hypertrophic Osteoarthropathy (Hoa)mentioning

confidence: 99%

The aetiology of clubbing and hypertrophic osteoarthropathy

Dickinson

1993

Eur J Clin Investigation

133

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Abstract. The evidence is reviewed for the hypothesis that clubbing and hypertrophic osteoarthropathy are due to the peripheral impaction of megakaryocytes and platelet clumps in the fingers and toes, to which this particulate matter has passed in an axial stream. The normal pulmonary vascular bed retains these large particles, which fragment before entering the systemic circulation. A right-to-left shunt allows them to bypass the pulmonary vascular bed. A preliminary histological report of platelet clumps seen at necropsy in nail bed capillaries of clubbed fingers supports the hypothesis. Platelets contain and release platelet-derived growth factor, whose known effects could explain all the pathological changes in clubbing. In addition to explaining why clubbing should occur in cyanotic congenital heart disease, clubbing in sub-acute bacterial endocarditis and distal to infected arterial grafts and aneurysms can be understood in terms of platelet clumps breaking off valves or arterial walls, and passing distally. Clubbing in liver disease is associated with multiple small pulmonary arteriovenous anastomoses which allow large particles through. Hypertrophic osteoarthropathy probably shares the same mechanism, and is mainly attributable to PDGF release; but there may also be altered platelet function and an additional growth factor derived from the lungs.

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“…Although HOA is most commonly associated with lung cancer and non-small cell lung cancers (NSCLCs) account for the majority of these, a wide range of other conditions are also associated with the condition: pulmonary diseases with systemic involvement such as congenital cyanotic heart disease,3 cystic fibrosis4 and others have been documented. Rheumatological diseases such as rheumatoid arthritis and ankylosing spondylitis have also been reported,5 as have hepatic diseases6 and chronic infections such as subacute bacterial endocarditis and acquired immune deficiency syndrome 7.…”

Section: Discussionmentioning

confidence: 99%

Treatment of painful hypertrophic osteoarthropathy associated with non-small cell lung cancer with octreotide: a case report and review of the literature

Birch

Jenkins

Noble

2011

BMJ Support Palliat Care

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Hypertrophic osteoarthropathy (HOA) is a syndrome most commonly associated with non-small cell lung cancer and consists of periostitis, digital clubbing and painful polyarthropathy. Its symptoms may be disabling and are reportedly difficult to manage effectively with conventional analgesia. We present a case of a lung cancer patient with opioid resistant painful HOA in whom analgesia was achieved with octreotide.

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Hypertrophic osteoarthropathy in cystic fibrosis.

Cited by 34 publications

References 12 publications

The musculoskeletal complications of cystic fibrosis

The musculoskeletal complications of cystic fibrosis

The aetiology of clubbing and hypertrophic osteoarthropathy

Treatment of painful hypertrophic osteoarthropathy associated with non-small cell lung cancer with octreotide: a case report and review of the literature

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