Pachydermodactyly: A Review

Abstract

Synovitis is the characteristic feature of inflammatory joint disease. If synovitis is localized to interphalangeal joints, rheumatoid arthritis, psoriatic arthritis, and juvenile idiopathic arthritis are among the most common differential diagnoses. The absence of pain, tenderness, and limitation of function despite progressive swelling of proximal interphalangeal joints suggests an alternative diagnosis, for example pachydermodactyly (PDD). This is a benign disease, associated with asymptomatic, progressive swelling of periarticular soft tissue, which usually occurs in young males. PDD is probably the result of repetitive mechanical stimulation. One hundred and twenty-one cases have been reported in the literature. Some of these were initially misdiagnosed and treated for inflammatory arthritis. We provide a comprehensive review of the literature on pachydermodactyly to promote awareness of this rare but important differential diagnosis of arthritis.

Teenage boy with thickened dorsal hands and feet

“…PPD can present with joint pain and as such can be confused with an inflammatory arthropathy. The pathogenesis is largely unknown, although it is thought to be related to mechanical friction, including frequent rubbing, stretching, and cracking of the fingers and hobbies and occupations such as weightlifting and martial arts . There have been correlations of cases with several psychiatric diseases, including obsessive‐compulsive disorder, Asperger syndrome, attention deficit hyperactivity disorder, mental retardation, and Tourette syndrome.…”

“…There have been correlations of cases with several psychiatric diseases, including obsessive‐compulsive disorder, Asperger syndrome, attention deficit hyperactivity disorder, mental retardation, and Tourette syndrome. In most cases, family members are not affected, although it has been reported in the literature …”

“…The most common clinical presentation is progressive, painless swelling of the proximal interphalangeal joints and thickening of the overlying skin, with the second to fourth digits affected. There is no loss of joint function . Bardazzi and colleagues proposed a classification scheme that describes five different presentations of PDD: classic (affecting one or more proximal interphalangeal joints and related to repeated trauma), localized (affecting a single joint), transgradient (extending to the dorsal hand and the metacarpophalangeal areas), familial, and associated with tuberous sclerosis .…”

Pachydermodactyly

“…Genellikle adolesan erkeklerde kompülsif davranışların sebep olduğu tekrarlayan minör travmaların bir sonucu olarak ortaya çıktığı düşünülmektedir (2). Nadir görülen bu hastalık, eklemlerde görülmesi ve şişmenin eşlik etmesi nedeniyle romatolojik hastalıklarla karışabilmektedir.…”

“…Proksimal interfalangeal eklemlerde şişmeye rağmen bu duruma ağrı, hassasiyet ve fonksiyon kısıtlılığının eşlik etmemesi alternatif ayırıcı tanı olarak pakidermodaktiliyi akla getirmelidir (2). Pakidermodaktili ilk olarak bir "knuckle pad" (eklem yastıkçığı) varyantı olarak tanımlanmasına rağmen günümüzde genellikle proksimal interfalangeal eklemlerin lateralinde asemptomatik periartiküler yumuşak doku şişliği ile karakterize farklı bir klinik antite olarak kabul edilmektedir (3).…”