This article presents an updated overview of hypertrophic osteoarthropathy and digital clubbing for the practicing rheumatologist. Discussion includes a brief historical perspective, its definition, incidence and prevalence, classification, pathology and pathophysiology, clinical manifestations, demographics, findings on physical examination, imaging techniques for its detection, differential diagnosis, and treatment modalities.
Key points
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Hypertrophic osteoarthropathy (HOA) syndrome comprises the combined presence of digital clubbing, periostosis, and joint swelling.
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HOA is divided into primary and secondary forms. Primary HOA is also known as pachydermoperiostosis. The secondary form of HOA has been associated with a wide variety of medical conditions, including malignancies.
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Involvement of vascular endothelial growth factor, platelet-derived growth factor, platelets, and genetically determined increased prostaglandin E 2 levels has been postulated in its pathogenesis.
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If clubbing or periostosis become evident in a previously healthy individual, a thorough search for an underlying illness should be undertaken.
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The management of HOA is dependent on the correction of the underlying disease. Analgesics, nonsteroidal antiinflammatory drugs, and bisphosphonates may relieve bone pain.
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