eMedicine Specialties > Rheumatology > Metabolic and Bone Disease

Hypertrophic Osteoarthropathy: Follow-up

Author: Richa Dhawan, MD, Faculty, Center of Excellence for Arthritis and Rheumatology, Louisiana State University Health Science Center at Shreveport
Coauthor(s): Mohammed Mubashir Ahmed, MD, Associate Professor, Department of Medicine, Division of Rheumatology, University of Toledo College of Medicine; Henri-Andre Menard, MD, Professor of Medicine, Director of Rheumatology, Department of Medicine, Division of Rheumatology, McGill University Health Center and McGill University; Director, The McGill Arthritis Center; Senior Physician, Shriner's Hospital for Crippled Children, Montreal
Contributor Information and Disclosures

Updated: Nov 7, 2008

Follow-up

Further Inpatient Care

Hypertrophic osteoarthropathy (HOA) itself does not require inpatient care; however, inpatient care may be required for associated conditions.

Further Outpatient Care

With specific curative treatment for the associated conditions, hypertrophic osteoarthropathy may remit with only analgesic and anti-inflammatory supportive treatment. Similarly, the symptomatic recurrences of hypertrophic osteoarthropathy in persons with cystic fibrosis are usually associated with pulmonary superinfections and can be controlled and prevented with appropriate curative or prophylactic antibiotic therapy.

Inpatient & Outpatient Medications

Any of the classic NSAIDs or the newer COX-2 inhibitors can be used at their usual dose as needed. These drugs do not influence the evolution of hypertrophic osteoarthropathy, but they are useful to control symptoms. Other analgesic medications (eg, acetaminophen, opioid analgesics) may be used.

Complications

The only complication of hypertrophic osteoarthropathy is secondary osteoarthritis observed in patients with long-standing hypertrophic osteoarthropathy.

Prognosis

At times, hypertrophic osteoarthropathy may be an ominous syndrome, but it does not add significantly to the mortality or morbidity of the associated diseases.

Patient Education

Patients first diagnosed with hypertrophic osteoarthropathy should be reassured regarding its good prognosis as a musculoskeletal condition. That being established, they should be informed of its significance and the need for further investigation to rule out any treatable associated disease. These investigations are guided by results from thorough clinical evaluations, including questions specifically targeting intrathoracic diseases.

Miscellaneous

Medicolegal Pitfalls

Because 90% of hypertrophic osteoarthropathy (HOA) cases are a paraneoplastic or parainfectious syndrome that can precede the diagnosis of the primary disease, a medicolegal pitfall may be encountered if the primary condition is missed. Because the diagnosis is essentially clinical in nature, the physician is expected to perform a systematic history and physical examination, including a screening examination of the musculoskeletal system, even in asymptomatic people. Thus, a good clinical practice is to always write in the clinical notes that physical examination findings are normal, eg, "The musculoskeletal examination findings are normal. No clubbing."

 


More on Hypertrophic Osteoarthropathy

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Differential Diagnoses & Workup: Hypertrophic Osteoarthropathy
Treatment & Medication: Hypertrophic Osteoarthropathy
Follow-up: Hypertrophic Osteoarthropathy
Multimedia: Hypertrophic Osteoarthropathy
References
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Further Reading

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Keywords

hypertrophic osteoarthropathy, primary hypertrophic osteoarthropathy, primary HOA, HOA, secondary HOA clubbing, Hippocratic fingers, clubbed digits, pachydermoperiostosis, acroosteolysis, Touraine-Solente-Golé syndrome, Goldbloom's syndrome, Goldbloom syndrome, Pierre Marie-Bamberger's disease, Pierre Marie-Bamberger disease, osteoarthropathie hypertrophiante pneumique, hypertrophic pulmonary osteoarthropathy, HPOA, acropachy, hyperhidrosis, digital clubbing, periostosis, intrathoracic malignancy, intrathoracic infection, cyanotic cardiac disease, cyanotic heart disease, congenital clubbing, familial clubbing, osteosarcoma, thyroid acropachy, Crohn disease, Crohn's disease, polyposis, thymoma, achalasia, Graves disease, Graves' disease, thalassemia, POEMS syndrome

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Contributor Information and Disclosures

Author

Richa Dhawan, MD, Faculty, Center of Excellence for Arthritis and Rheumatology, Louisiana State University Health Science Center at Shreveport
Richa Dhawan, MD is a member of the following medical societies: American Association of Physicians of Indian Origin, American College of Physicians-American Society of Internal Medicine, and American College of Rheumatology
Disclosure: Nothing to disclose.

Coauthor(s)

Mohammed Mubashir Ahmed, MD, Associate Professor, Department of Medicine, Division of Rheumatology, University of Toledo College of Medicine
Mohammed Mubashir Ahmed, MD is a member of the following medical societies: American College of Physicians, American College of Rheumatology, and American Federation for Medical Research
Disclosure: Nothing to disclose.

Henri-Andre Menard, MD, Professor of Medicine, Director of Rheumatology, Department of Medicine, Division of Rheumatology, McGill University Health Center and McGill University; Director, The McGill Arthritis Center; Senior Physician, Shriner's Hospital for Crippled Children, Montreal
Henri-Andre Menard, MD is a member of the following medical societies: American College of Rheumatology, Canadian Medical Association, Canadian Rheumatology Association, and Quebec Medical Association
Disclosure: Nothing to disclose.

Medical Editor

Bryan L Martin, DO, Chief, Allergy Immunology Department, Walter Reed Army Medical Center; Associate Professor of Medicine and Pediatrics, Uniformed Services University of the Health Sciences; United States Army Consultant in Allergy Immunology and Immunizations
Bryan L Martin, DO is a member of the following medical societies: American Academy of Allergy Asthma and Immunology, American College of Allergy, Asthma and Immunology, American College of Osteopathic Internists, American College of Physicians, American Medical Association, and American Osteopathic Association
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Lawrence H Brent, MD, Associate Professor of Medicine, Thomas Jefferson University; Chair, Program Director, Department of Medicine, Division of Rheumatology, Albert Einstein Medical Center
Lawrence H Brent, MD is a member of the following medical societies: American Association of Immunologists, American College of Physicians, and American College of Rheumatology
Disclosure: Genentech Honoraria Speaking and teaching; Genentech Grant/research funds Other; Amgen Honoraria Speaking and teaching; Wyeth Honoraria Speaking and teaching; Abbott Immunology Honoraria Speaking and teaching

CME Editor

Alex J Mechaber, MD, FACP, Associate Dean for Undergraduate Medical Education, Associate Professor of Medicine, University of Miami Miller School of Medicine
Alex J Mechaber, MD, FACP is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians-American Society of Internal Medicine, and Society of General Internal Medicine
Disclosure: Nothing to disclose.

Chief Editor

Herbert S Diamond, MD, Professor of Medicine, Temple University School of Medicine; Chairman Emeritus, Department of Internal Medicine, Western Pennsylvania Hospital
Herbert S Diamond, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians, American College of Rheumatology, American Medical Association, and Phi Beta Kappa
Disclosure: medifocus Honoraria Review panel membership; health dialogs Honoraria Consulting; Merck, Amgen, Biogen, Zimmer, Wyeth, Johnson&Johnson, Stryker, Medtronic, Zimmer.Abbott,  Ownership interest Other; West Penn Allegheny Health System Consulting fee Consulting; Alpharma Honoraria Consulting; Proctor&Gamble Grant/research funds Independent contractor

 
 
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