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Hypertrophic pulmonary osteoarthropathy (HPOA) is a rare paraneoplastic syndrome. Our literature review shows the location of arthralgia and existence of edema are referable information for the differential diagnosis in paraneoplastic arthralgia.

Hypertrophic osteoarthropathy (HOA) is a syndrome that consists of periostitis, digital clubbing, and painful polyarthropathy. The management and prognosis of HOA is dependent on the underlying disease process. Recognising and treating it accordingly will reduce the symptom burden of patients. We present a case of a patient diagnosed with non-small cell lung cancer and HOA suffering from severe pain, and review specific therapies for the management of HOA-related pain.

Solitary fibrous tumors are rare pleural tumors. Most of the time they are benign tumors and identified incidentally once they cause symptoms secondary to their mass effect. Here we present an interesting case of a 54-year-old female found with a giant solitary fibrous tumor with signs of hypertrophic pulmonary osteoarthropathy with associated digital clubbing 6 month before identifying the tumor. The initial percutaneous biopsy revealed pathologic findings consistent with benign solitary fibrous tumor, but after complete mass excision diagnosis was upgraded to a malignant solitary fibrous tumor. Percutaneous biopsy results should not guide therapy in these patients; this is why complete excision continues to be the treatment of choice.

Hypertrophic pulmonary osteoarthropathy (HPOA) is a well‐documented complication of pulmonary malignancy and cystic fibrosis (CF). However, HPOA associated with exacerbations of non‐CF bronchiectasis has only been reported once previously in an adolescent. We describe a case of an adult patient with bronchiectasis and HPOA, whose joint symptoms flared during pulmonary exacerbations and improved with treatment of each exacerbation., We describe a case of an adult patient with bronchiectasis and hypertrophic pulmonary osteoarthropathy (HPOA), whose joint symptoms flared during pulmonary exacerbations and improved with treatment of each exacerbation.

Hypertrophic pulmonary osteoarthropathy (HPOA) is a paraneoplastic manifestation of gastric and, more frequently, lung carcinomas. It is characterized by extremity pain, clubbing, arthritis and periostitis of the long bones. Periostitis is the hallmark of HPOA and can be revealed with bone scintigraphy. Whole-body bone scintigraphy (WBBS) is very sensitive during the active lesion period and WBBS findings usually precede that of plain radiography. WBBS can also show improvement in the first 6 months following treatment, thus making it an important technique in the management and follow-up of these patients. While HPOA findings are usually seen in the lower extremities, involvement of both upper and lower extremities is a rare condition. In this case report, it is aimed to present findings of a 67-year-old male patient with lung cancer and complaint of extremity pain. We report on this patient to draw attention to HPOA of both upper and lower extremities.Hipertrofik pulmoner osteoartopati (HPOA), mide ve özellikle akciğer kanserlerinde görülebilen bir paraneoplastik sendromdur. Çomak parmak, artrit, ekstremite ağrısı ve uzun kemiklerde periostit ile karakterizedir. Periostit HPOA’nın ayırıcı bulgularındandır ve sintigrafi ile gösterilebilir. Sintigrafik bulgular çoğunlukla radyolojik bulgulardan önce ortaya çıkar. Tüm vücut kemik sintigrafisi (TVKS) aktif lezyon döneminde oldukça duyarlıdır. TVKS ile tedavi sonrası ilk 6 ayda bulgularda gerileme gösterilebilir. Dolayısıyla TVKS, bu hastaların tanı ve takibinde önemli bir yer tutar. HPOA bulguları çoğunlukla alt ekstremitede görülür; hem üst hem alt ekstremite tutulumu nadir görülen bir durumdur. Bu olgu takdimi, ekstremite ağrısı ile başvuran akciğer kanseri hastalarında, hem alt hem üst ekstremitede nadiren görülen HPOA tablosuna dikkat çekmek amacıyla sunulmaktadır.

A male Afro-descendant patient, 57 years old, complaining of polyarticular involvement and weight loss for 18 months, with a load of 13.5 pack years of smoking. On physical examination there was pain on palpation of the right knee and right leg, with signs of inflammation on the knee. We also observed digital clubbing in all fingers. Antinuclear antibodies (ANA) and anti-Sm antibodies were positive. X-rays of the legs and arm showed cortical thickening of long bones. The computed tomography demonstrated a large mass located in the middle lobe of the right lung. The anatomopathological study revealed a bronchial adenocarcinoma. The history of polyarticular involvement associated with positive anti-Sm and ANA antibodies could lead to an erroneous diagnosis of systemic lupus erythematosus. Considering the bad consequences of delayed diagnosis in this patient, the medical team should be alerted for suspecting and look for a lung cancer under these circumstances.

Introduction This study examined the frequency of hypertrophic pulmonary osteoarthropathy (HPO) and the clinical characteristics of lung cancer with HPO. Methods The results of 2625 lung cancer patients who underwent bone scintigraphy were reviewed to identify patients with HPO, which was diagnosed when the bone scintigram showed a diffuse, symmetric pattern of bilateral increased uptake in the long tubular bones. Clinical characteristics were investigated based on the clinical and pathologic records. Results Nineteen patients (0.72%) were found to have HPO: 17 were men, 17 were heavy smokers, and 13 had clinical stage IIIB or IV disease. Ten patients complained of pain or edema in the extremities, and seven of them had stage IIIB or IV disease. In four patients with clinical stage IIIB or IV disease, HPO was not detected at the first presentation, and the diagnosis was made after disease progression. The symptoms of HPO improved in two patients who underwent surgical resection but in only three of five patients who received chemotherapy. The HPO findings on the bone scintigram improved in 2 of 3 patients who underwent surgical resection and 5 of 11 patients who received chemotherapy. Conclusions Less than 1% of the lung cancer patients developed HPO as a paraneoplastic manifestation. Males, heavy smokers, and advanced disease predominated in lung cancer patients with HPO. The symptoms and bone scintigram findings of HPO improved in half of the patients on treating the lung cancer.

Hypertrophic Pulmonary Osteoarthropathy: Images with Significant Changes Post Lung Tumor Resection To access and investigate a middle-aged nonsmoking male who presented rheumatoid arthritis with swelling and pain in bilateral knees, and clubbing of the fingers and toes for more than one and a half years.

The authors review the most important contributions of Pierre Marie to the elucidation and description of several neurological diseases, such as Charcot-Marie-Tooth’s disease and hereditary cerebellar ataxia, as well as his contributions to Internal Medicine, including his pioneering studies on acromegaly, ankylosing spondylitis, and hypertrophic pulmonary osteoarthropathy. His works led to incontestable advances in the medical sciences that transcended his time. Os autores revisaram as mais importantes contribuições de Pierre Marie para a elucidação e a descrição de várias doenças neurológicas, tais como a doença de Charcot-Marie-Tooth e a ataxia cerebelar hereditária, bem como na medicina interna, incluindo os seus estudos pioneiros na acromegalia, espondilite anquilosante e osteo-artropatia hipertrófica pulmonar. Os seus trabalhos promoveram uma crescimento incontestável das ciências médicas que transcenderam o seu tempo.

We present a case of a 47 year-old African American female with 15 pack-years of tobacco use and heavy alcohol use who presented with arthritis and was found to have a positive antinuclear antibodies (ANA), anti double stranded DNA antibodies (anti-dsDNA), and anti-Sjogren’s syndrome-related antigen A and antigen B (anti-SSA and anti-SSB). She was subsequently found to have a lung adenocarcinoma associated with hypertrophic pulmonary osteoarthropathy (HPO). This demonstrates a case of positive antinuclear antibodies and arthritis in a patient with lung adenocarcinoma, which can be falsely diagnosed as systemic lupus erythematosus.

Hypertrophic pulmonary osteoarthropathy is characterized by proliferation of the skin and periosteal formation of new bone.

Hipertrophic Pulmonary Osteoarthropathy (HPO) merupakan sindrom paraneoplastik yang disebabkan oleh kelainan pada paru-paru. Angka kejadian HPO sangat rendah yaitu kurang dari 1%, dimana penyebab yang tersering (90%) adalah karsinoma bronkogenik. Gambaran klinis HPO timbul akibat kelainan sistemik pada sendi dan jaringan lunak berupa pembengkakan pada jari-jari, pembentukan tulang baru terutama pada tulang panjang ekstremitas bawah, serta gambaran menyerupai artristis pada sendi dan jaringan periartikuler (pergelangan kaki, lutut, pergelangan tangan dan siku). Beberapa penelitian telah melaporkan manfaat sidik tulang (bone scintigraphy) untuk penegakkan diagnosis dan penilaian pasca terapi pada HPO. Sidik tulang selain untuk menegakkan diagnosis dan mengetahui adanya metastasis, juga dapat menggambarkan secara lebih jelas keberadaan dan luasnya aktivitas sub-periosteal dibandingkan pemeriksaan radiologi. Berikut dilaporkan kasus HPO yang awalnya didiagnosis sebagai osteoarthritis dari pemeriksaan radiologi, selanjutnya didiagnosis dengan karsinoma bronkogenik dengan HPO dari pemeriksaan sidik tulang.

Hypertrophic osteoarthropathy (HOA) typically occurs concurrently with clubbing of the digits, with isolated HOA being reported only rarely. We report two patients with intra-thoracic malignancy in whom HOA, demonstrated on bone scintigraphy, developed in the absence of clubbing. We also report the novel observation of involvement of the metatarsal and metacarpal bones by HOA.

We describe an extremely rare case of a woman with pulmonary metastatic disease from breast cancer, who presented with features of hypertrophic pulmonary osteoarthropathy (HPOA). Pain associated with HPOA may be extremely disabling and resistant to treatment. Treatment with pamidronate, an inhibitor of osteoclastic bone resorption, given every 2 weeks by i.v. drip infusion, led to rapid disappearance of uncontrolled pain caused by HPOA.

Arthralgia is a common complaint in cystic fibrosis (CF) patients (1). A minor subset of these patients have hypertrophic pulmonary osteoarthropathy (HPOA) or episodic arthritis (EA), presenting wi...

Background: Hypertrophic pulmonary osteoarthropathy (HPOA) secondary to bronchogenic carcinoma can be associated with severe, disabling pain which is not always responsive to conventional treatment. Aim: To report on the use of pamidronate to control resistant pain in HPOA in three cases. Methods: A retrospective review of reported pain, chest X-ray and radionuclide bone scans was made. Results: Pain relief was achieved in all three cases together with reduced radiolabel uptake in two cases. Conclusions: Pamidronate appears to be an effective therapy for HPOA. Further investigation is warranted.

Background Arthritis remains a relatively infrequent complication of cystic fibrosis, but is a cause of significant morbidity when it does occur. Two distinct types of arthritis are described in cystic fibrosis: cystic fibrosis-related arthropathy (CFA) and hypertrophic pulmonary osteoarthropathy (HPO). Management of arthritis in people with cystic fibrosis is uncertain and complex because of the underlying disease and its intense treatment. This is an update of a previously published review. Objectives To review the effectiveness and safety of pharmacological agents for the symptomatic management of cystic fibrosis-related arthritis in adults and children with cystic fibrosis. Search methods We searched the Cochrane Cystic Fibrosis and Genetic Disorders Group Trials Register which comprises references identified from comprehensive electronic database searches, handsearches of relevant journals and abstract books of conference proceedings. Date of most recent search: 19 January 2016. Selection criteria Randomised controlled studies which compared the efficacy and safety of anti-inflammatory and analgesic agents (e.g. non-steroidal anti-inflammatory agents, systemic corticosteroids, intra-articular corticosteroids) with each other, with no treatment or with placebo for CFA and HPO. Data collection and analysis No relevant studies were identified. Main results No studies were included in this review. Authors' conclusions Although it is generally recognised that CFA may be episodic and resolve spontaneously, treatment with analgesics and anti-inflammatory agents may be needed. While this approach may be sufficient to manage symptoms, it is disappointing that no randomised controlled trials to rigorously evaluate these agents were found, nor could the authors identify any quasi-randomised. This systematic review has identified the need for a well-designed adequately-powered randomised controlled trial to assess the efficacy and safety of pharmacological agents for the symptomatic management of cystic fibrosis-related arthritis (CFA and HPO) in adults and children with cystic fibrosis. Studies should also better define the two conditions. A study has recently been conducted in CFA and may help fill this gap when analysed and published. There are no trials included in the review up to January 2016. We will continue to run searches to identify any potentially relevant studies; however, we do not plan to update other sections of the review until new studies are published.

A 42-year-old male presented to the emergency department with difficulty breathing and body pain particularly in his bilateral lower extremities. A workup was done and he was diagnosed with sarcomatoid carcinoma of the lung. Bone scintigraphy was performed and hypertrophic pulmonary osteoarthropathy was diagnosed to be the source of the pain.

We report here a case of intrathoracic undifferentiated carcinoma in the thymus with hypertrophic pulmonary osteoarthropathy in a 13-year-old girl. The association of the two conditions is very rare.

Hypertrophic pulmonary osteoarthropathy (HOA) is a condition associated with lung cancer and many other diseases. Pain associated with HOA can be disabling, unremitting, and refractory to conventional analgesic medications. We present a challenging case of HOA in a patient with nonsmall cell lung cancer and review specific therapies for management of HOA-related pain.

We present a case of a woman with pulmonary metastatic disease from breast carcinoma who presented with features of pulmonary osteoarthropathy (HPOA). We document the unusual presentation with classical features of HPOA in the absence of finger clubbing and the response of the scintigraphic appearances to antitumour chemotherapy.

We report on a 28-year-old man with known cystic fibrosis who presented with pain and cutaneous nodules in the elbow joints. His symptoms had appeared episodically in the previous months, they were always self-limiting, and independent of pulmonary exacerbations. A radiograph of the joints was unremarkable. These findings fit well with a special form of CF-related arthritis. As in the case of classical CF arthritis, the treatment to be considered is, in particular, symptomatic administration of non-steroidal anti-inflammatory drugs and possibly glucocorticoids. Also under discussion as a further possibility is the use of antibiotics. Our patient has always refused medication. The condition again proved to be self-limiting. In contrast to the classical form of CF arthritis, the special form is not associated with either joint swelling or local warmth. In the presence of arthritic symptoms in CF patients, consideration must always be given to a hypertrophic pulmonary osteoarthropathy. The latter, however, shows typical radiological changes and is exacerbated by lung infections. The presence of arthritic pathologies in a patient with CF further underscores the fact that CF is a multiorgan morbid condition.

Clubbing and hypertrophic pulmonary osteoarthropathy (HPOA) are two components of a clinical syndrome which is more accurately referred to as hypertrophic osteoarthropathy (HOA). HOA occurs as a rare familial primary form and a more common secondary form, which is always due to an underlying disease process. Secondary HOA is now recognized as the correct term for HPOA. The reason for this confusing nomenclature is that HPOA was historically thought only to occur associated with pulmonary disease. However, this is now recognized to be incorrect since numerous diseases affecting other organ systems, such as congenital cyanotic heart disease, are also complicated by clubbing and secondary HOA. Despite the clinical phenomena of HOA being recognized since the time of Hippocrates, the exact pathophysiological events responsible for these changes remain unknown. Various hypotheses including the production of paraneoplastic hormones, intrapulmonary shunting of blood resulting in peripheral platelet degranulation and the associated elaboration of growth factors, and the reappearance of the embryonic claw due to reactivation of dormant genes have been suggested as plausible mechanisms for this condition, but none is universally accepted. Although pulmonary suppuration commonly gives rise to clubbing and secondary HOA, primary lung neoplasia is responsible for the majority of pulmonary cases of this syndrome, meaning that the manifestation of the clinical phenomena of this condition should be investigated with a great deal of suspicion. Although analgesic agents can treat the pain associated with this syndrome, unfortunately, there is no specific treatment for clubbing and secondary HOA other than eradication of the underlying disease process.

We report the cases of two middle-aged male smokers who presented to the early synovitis clinic with an acute phase response, synovitis of the wrists and ankles and clubbing of the fingers, but no respiratory symptoms. Both proved to have primary lung tumours with hypertrophic pulmonary osteoarthropathy, in one case resolving promptly with treatment of the carcinoma. We review the literature, including theories on pathogenesis.

Six patients (5 male and 1 female) aged 55 to 65 years, with right-sided bronchial tumors, presented with severe pain due to hypertrophic pulmonary osteoarthropathy. The diagnosis was confirmed at mediastinoscopy, which also demonstrated extensive mediastinal node involvement. As lung resection in these circumstances is not advisable, we took the opportunity of performing vagotomy through the mediastinoscope. There was immediate relief of pain following transcervical vagotomy in all patients. Two patients were pain free until time of death, 5 and 9 months respectively. One patient underwent radiotherapy to the primary lung tumor after mediastinoscopy and vagotomy, and was pain free until her death 14 months later. However, in 3 patients this benefit was short-lived and the pain recurred within 4 weeks. Following radiotherapy to the bronchial tumor, the pain was relieved. Mean follow-up time was 18 months (range, 5 to 36 months). These findings cast an interesting light on the function of the vagus nerve and the nature of hypertrophic pulmonary osteoarthropathy, and the technique affords a means of relieving the persistent and distressing pain, albeit temporary.

Case reports are accepted under this heading. These reports should be short and concise and contain a minimum of figures, tables and references.

This case presents a patient with hypertrophic osteoarthropathy of the lower extremities that developed secondary to congenital cyanotic heart disease. The major clinical manifestation was severe bilateral leg pain. The pain that was debilitating in nature completely resolved following a single administration of 60 mg pamidronate. Hypertrophic osteoarthropathy (HOA) is an acquired, uncommon disorder of obscure etiology. It has been described mainly in association with chronic suppurative pulmonary diseases, bronchogenic carcinoma and lung metastases, cystic fibrosis, and cyanotic congenital malformations of the heart.