A. Characteristics
- Abnormal proliferation of skin and osseous structures at distal extremities
- Clubbing is very prominant [2]
- Periostosis of the tubular bones with synovial effusions
- Likely due to abnormal activation of endothelium by platelets
- Primary and secondary disease
B. Classification of Secondary HPOA
- Cardiac
- Congenital cyanotic disease
- Infective endocarditis
- Pulmonary Disease
- Cystic Fibrosis
- Pulmonary Fibrosis
- Cancer: primary or metastatic
- Chronic Infections
- Mesothelioma
- Arteriovenous Fistula
- Hepatic
- Cirrhosis
- Carcinoma
- Intestinal
- Inflammatory bowel disease
- Chronic infections
- Laxative abuse
- Gastrointestinal polyposis
- Malignant tumors
- Mediastinal
- Esophageal Ca
- Thymoma
- Achalasia
- Miscellaneous
- Graves' Disease
- Thalassemia
- Other malignancy
- Infective arteritis
- Hemiplegia
- Antiphospholipid antibodies may be present
- POEMS Syndrome has been added recently
C. Management
- Detection of clubbing: profile angle and phalangeal depth ratio for quantitation [2]
- Usually asymptomatic
- Main problem is appearance
- Correction of underlying disorder may sometimes (partially) reverse HTOA
- Nonsteroidal antiinflammatory drugs (NSAIDS) may be effective in painful cases
References
- Martinez-Lavin M. 1997. Curr Opin Rheumatol. 9(1):83
- Myers KA and Farquhar DRE. 2001. JAMA. 286(3):341