Hypertrophic Osteoarthropathy Differential Diagnoses

Updated: Jan 08, 2018
  • Author: Richa Dhawan, MD, CCD; Chief Editor: Herbert S Diamond, MD  more...
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Diagnostic Considerations

Inflammatory arthropathy may be incorrectly diagnosed in cases of malignant lung tumors, in which painful arthropathy can be the presenting feature of hypertrophic osteoarthropathy (HOA). Hypertrophic osteoarthropathy is more likely when the following factors are present:

  • Pain that extends beyond the joint into the adjacent bone
  • Absence of rheumatoid factor
  • Noninflammatory synovial fluid.

Acromegaly may be suggested in cases of exuberant skin hypertrophy and enlarged hands and feet. [95]  Normal growth hormone levels and the absence of both prognathism and enlarged sella turcica exclude acromegaly.

Fingertip changes due to other conditions that may be confused with hypertrophic osteoarthropathy include spooning of nails secondary to iron deficiency anemia, calcific deposits in distal digital pads of patients with scleroderma, and sarcoid involvement of the digit.

Disease s associated with periostitis with predominant location of periostitis should be included in the differential diagnoses, as follows:

  • Hypertrophic osteoarthropathy - Distal diaphysis of long bones and metacarpal joints

  • Psoriatic onycho-pachydermo periostitis - Terminal phalanx

  • Psoriatic arthritis - Phalanges of fingers and toes

  • Reactive arthritis - Phalanges of fingers and toes

  • Athletic overuse (running, jumping) - Upper and lower extremities

  • Ossifying fasciitis - Variable

  • Periostitis ossificans - Variable

  • Polyarteritis nodosa - Lower extremities

  • Facial infections - Mandible, orbita

  • Florid reactive periostitis - Phalanges of hands and feet

  • Osteoblastoma - Variable

  • Bizarre parosteal osteochondromatous proliferation (Nora tumor) - Bones of the hands and feet

  • Chondrosarcoma - Variable

  • Treatment with IL-11 - Clavicle, long bones

  • Osteomyelitis - Variable

  • Chronic leg ulcers - Tibia

  • Synovitis-acne-pustulosis-hyperostosis (SAPHO) syndrome - Variable

Pretibial edema may be due to thrombophlebitis, venous stasis, or pretibial myxedema and may mimic periostosis.

The importance of recognizing hypertrophic osteoarthropathy cannot be overstated. A previously healthy individual with any manifestation of the syndrome should undergo a thorough evaluation for an underlying illness. Direct special attention toward the chest.