Hypertrophic osteoarthropathy in the paediatric age.

Hypertrophic osteoarthropathy should be considered in any child who presents with a non-inflammatory synovitis of the knees, ankles and wrists and particularly if there is finger clubbing or soft tissue hypertrophy of the fingers. It is rare to get the typical facial appearances until after adolescence. Alteration in epiphyseal growth is associated with the periosteal reaction, as is change in the shape of the patella; whether this leads to premature osteoarthrosis is not yet certain. Secondary disease is common in cyanotic congenital heart disease, but its frequency appears to be decreasing with early treatment of such children. Chest infections are also better controlled so again it is less common, but does still occur, particularly in cystic fibrosis in the older age group who have intractable chest infections. It is seen but rarely in disorders such as inflammatory bowel disease or pulmonary metastases, particularly from bone tumours.