Hypertrophic Pulmonary Osteoarthropathy: A Rare But Treatable Condition in Palliative Medicine

Hypertrophic osteoarthropathy as a paraneoplastic manifestation of lung cancer.

“…The secondary form is more frequently observed in adults and is related with such conditions as lung cancer, cystic fibrosis, congenital heart disease, and an assortment of other disorders. Among malignancy-related HOA, pulmonary malignancies make up 80% of reported HOA cases, out of which the majority are NSCLC, for example adenocarcinoma or squamous cell carcinoma [3][4][5].…”

“…Pathogenesis of HOA still remains unclear, with several mechanisms being proposed. VEGF, platelet-derived growth factor, prostaglandin E, and other cytokines may play a role in causing the periostitis and digital changes in HOA [4,5]. Receptors for VEGF have been found in subperiosteal bone-forming cells, and high levels of VEGF have been found in virtually all the diseases associated with secondary HOA (but not seen in congenital cyanotic heart disease) and in primary HOA; these levels correlate to levels of underlying disease activity.…”

“…The tyrosine kinase inhibitor gefitinib has also been shown to resolve symptoms as well as providing resolution of radiological findings. The current management of the symptoms of HOA includes conventional analgesia working up the WHO analgesic ladder, as well as non-steroidal medication and practical measures such as physiotherapy [1,3,4].…”

“…Niejednokrotnie leczenie paliatywne jest głównym celem leczenia pacjentów chorych na nowotwory, a złagodzenie bólu staje się największym wyzwaniem dla lekarzy. Osteoartropatia przerostowa jest scho-rzeniem niezwykle bolesnym, występującym głównie u pacjentów z pierwotnym nowotworem płuc, zespołami paranowotworowymi, a ból w tym przypadku jest często oporny na działanie konwencjonalnych leków przeciwbólowych [3,4]. W niniejszym artykule przedstawiono przypadek pacjenta, u którego zdiagnozowano NSCLC i HOA, borykającego się z silnym bólem, oraz dokonano przeglądu konkretnych metod leczenia bólu związanego z HOA.…”

“…Sometimes palliation is the mainstay of treatment for cancer patients, and alleviating pain becomes very challenging for the physicians. Hypertrophic osteoarthropathy is such a painful condition occurring mainly in patients with primary lung cancer and paraneoplastic syndromes, and pain in this condition is often resistant to conventional analgesic medications [3,4]. Herein, in order to manage HOA-related symptoms in a patient diagnosed with non-small cell lung cancer, we present a case report and address possible therapies for pain relief.…”