Hypertrophic osteoarthropathy

Synonyms

HOA, pulmonary hypertrophic osteoarthropathy, Hippocratic fingers, pachydermoperiostosis, Touraine-Solente-Golé syndrome, clubbing.

Definition

Patients with hypertrophic osteoarthropathy (HOA) have either or both periostitis of the long bones and clubbing of digits. They may also have poly- or oligo-arthritis. HOA may be either primary or secondary, the latter being most commonly associated with an underlying neoplastic or infectious disease. Clubbing occurs in all forms of HOA and results from an increase in connective tissue of the nail bed. There is initial softening of the nail bed, loss of the usual 15-degree angle between the nail and the nail bed at the cuticle, accentuation of the convexity of the nail, and shininess of the skin near the nail.

Primary HOA (pachydermoperiostosis, Touraine-Solente-Golé syndrome) is usually familial. Transmission is by an autosomal dominant gene with variable expression. Symptoms usually begin around puberty with insidious development of...