Hypertrophic Osteoarthropathy on Bone Scintigraphy

Abstract

We present the case report of a patient with a history of lung cancer in whom the typical pattern of hypertrophic osteoarthropathy was seen on bone scintigraphy. We discuss the etiologies, pathophysiology, and management of this entity.

Hypertrophic Osteoarthropathy: A Case of an Undifferentiated Polyarthritis

“…Clinically, the musculoskeletal symptoms accompany the course of the disease [2,8]. Thus, the symptoms disappear with the treatment of the neoplasm, and their recurrence coincides with tumor relapse [2,8]. In this case report, we describe a representative case of a young patient with musculoskeletal symptoms suggestive of a rheumatic disease which was later found to be a paraneoplastic syndrome.…”

“…Hypertrophic osteoarthropathy (HOA) is a rare paraneoplastic disease that can be extremely debilitating [1]. The primary form of HOA is not associated with any other medical condition [2]. The secondary form, previously referred to as hypertrophic pulmonary osteoarthropathy, is usually associated with primary lung malignancies, particularly non-small cell lung carcinoma [2,3].…”

“…The primary form of HOA is not associated with any other medical condition [2]. The secondary form, previously referred to as hypertrophic pulmonary osteoarthropathy, is usually associated with primary lung malignancies, particularly non-small cell lung carcinoma [2,3]. In fact, periosteal reaction involving long bones, without history of trauma or an underlying bone lesion, should lead to prompt investigation of secondary causes [3].…”

“…HOA is characterized by the clinical triad of oligoarthritis or polyarthritis, clubbing of the fingers, and periostitis of the distal ends of long bones [2,[4][5][6]. Arthritis is the most frequent feature and affects most predominantly the knees, ankles, elbows, wrists, and metacarpophalangeal (MCP) and proximal interphalangeal (PIP) joints [7,8].…”

“…Some factors should raise suspicion of paraneoplastic syndromes, namely: personal or family history of neoplasia, exposure to carcinogens, constitutional symptoms, age over 50 years at diagnosis, and disease refractory to treatment [10]. Clinically, the musculoskeletal symptoms accompany the course of the disease [2,8]. Thus, the symptoms disappear with the treatment of the neoplasm, and their recurrence coincides with tumor relapse [2,8].…”