Chief Rheumatology Department. National Institute of Cardiology, Juan Badiano 1, 14080, Mexico City, Mexico.
Best Pract Res Clin Rheumatol. 2020 Jun;34(3):101507. doi: 10.1016/j.berh.2020.101507. Epub 2020 Apr 11.
Hypertrophic osteoarthropathy (HOA) is an orphan syndrome characterized by abnormal proliferation of the skin and osseous tissues at the distal parts of the extremities. The main clinical features are: a peculiar bulbous deformity of the tips of the digits conventionally described as "clubbing," periosteal proliferation of the tubular bones, and synovial effusions. In most instances, HOA develops a reaction to a severe internal illness, such as lung cancer, cyanotic heart disease, or liver cirrhosis. There is a subgroup of patients who do not have underlying pathology. Such cases are classified as having primary HOA. Digital clubbing is easy to recognize. Any patient with newly developed digital clubbing should undergo careful search for an underlying illness with special attention to intra-thoracic pathologies. Painful HOA is treated with non-steroidal anti-inflammatory medications. Vascular endothelial growth factor and prostaglandin E2 have been proposed as key bone proliferating mediators.
肥大性骨关节病（HOA）是一种孤儿综合征，其特征为四肢远端皮肤和骨骼组织的异常增生。主要的临床特征为：通常描述为“杵状指”的指尖奇特的球状畸形、管状骨的骨膜增生和滑液渗出。在大多数情况下，HOA 是对严重内部疾病的反应，如肺癌、发绀性心脏病或肝硬化。有一组患者没有潜在的病理学。此类病例被归类为原发性 HOA。杵状指很容易识别。任何新出现杵状指的患者都应仔细寻找潜在疾病，特别注意胸腔内病变。疼痛性 HOA 用非甾体抗炎药治疗。血管内皮生长因子和前列腺素 E2 已被提议作为关键的骨增殖介质。
