Review of current therapies for secondary hypertrophic pulmonary osteoarthropathy

Abstract

Hypertrophic osteoarthropathy (HOA) is a disabling condition that may occur secondarily to primary lung cancer. It is characterized by digital clubbing, arthralgia/arthritis, and periostosis of the tubular bones. The pain associated with HOA can be disabling and often refractory to conventional analgesics. We performed a comprehensive review of the literature using the PubMed database on treatment modalities available for HOA. We found 52 relevant articles-40 case reports, six case series, two review papers, and four combined case series and review papers. There were no randomized controlled trials reported. We then classified treatments used for HOA into two categories: (1) treatment of primary cause (i.e., resection of tumor, chemotherapy, radiotherapy, treatment of infection, etc.) and (2) symptomatic treatments (i.e., bisphosphonates, octreotide, NSAIDs, vagotomy, etc.). Subsequently, we summarized the main findings for each treatment. Although the clinical diagnosis of HOA has existed for over 100 years, the pathogenesis mechanism has not yet been elucidated, and treatment options for this condition remain experimental. Primary treatment is the most widely reported modality to be efficacious. In cases which primary therapy is not possible, several symptomatic treatment modalities are suggested, with various degree of success. Further research is needed to clarify the pathophysiological mechanism of HOA as to appropriately direct therapy.

Hypertrophic osteopathy in a dog associated with intra-thoracic lesions: a case report and a review

“…In animals, the term hypertrophic osteoarthropathy has not been used because the joints are not really involved (Montgomery, 2003;Piermattei et al, 2006); however, in human medicine, the term "osteoarthropathy" is still preferred because cases present with inflammatory arthritis (Armstrong et al, 2007;Dabir et al, 2007;Karkucak et al, 2007;Latos-Bielenska et al, 2007;Martinez-Ferrer et al, 2009;Nguyen and Hojjati, 2011).…”

“…Treatment of the primary cause includes tumour resection, radiotheraphy, chemotherapy, treatment of infection, replacement of infected grafts, organ transplantation and surgical correction of cyanotic heart disease. Symptomatic treatments include vagotomy, bisphosphonates, octreotide, application of epidermal growth factor receptor (EGFR) inhibitor and adrenergic antagonists (Nguyen and Hojjati, 2011).…”

Primary idiopathic hypertrophic osteoarthropathy in a child: characteristics of the disease with a case report

“…Медицинская помощь носит паллиативный характер и включает в себя применение нестероидных противовоспалительных пре-паратов (НПВП), глюкокортикоиды, тамоксифен, рети-ноиды и бисфосфонаты. Все эти препараты используются преимущественно для уменьшения болевого синдрома, связанного с явлениями полиартрита либо остеоартропа-тией [12]. Колхицин и глюкокортикоиды могут оказаться эффективными при болевом синдроме, связанном с суб-периостальным формированием новой костной ткани, поскольку ингибируют хемотаксис нейтрофилов и тем са-мым уменьшают отек тканей, являющийся причиной бо-лей.…”

“…Вторичная ГОА редко встречается у детей и подростков, наиболее часто она отмечается у лиц в возрасте 55-75 лет [12]. Клиническая картина ГОА варьирует в зависимости от темпов возникновения и эволюции основного заболевания.…”

The lung cancer nurse role in the management of paraneoplastic syndromes in lung cancer

“…The metacarpal, metatarsal, and phalangeal bones may also be involved which can result in finger clubbing. As well as treatment of the primary cancer symptomatic interventions can also include the use of nonsteroidal anti-inflammatory drugs (NSAID) and opiates with case reports showing Bisphosphonates and Octreotide being potentially effective (38).…”