HPOA — SCE Rheumatology MCQ

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ModerateConnective Tissue DiseaseHPOASCE Rheumatology

A 60-year-old man with recently diagnosed bronchogenic carcinoma develops symmetrical painful swelling of the wrists and ankles. Examination shows digital clubbing. Plain radiographs demonstrate symmetrical periosteal new bone formation along the distal radius, ulna, tibia and fibula. What is the most likely diagnosis?

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Correct answer: C — Hypertrophic pulmonary osteoarthropathy

The diagnosis is hypertrophic pulmonary osteoarthropathy. The discriminating combination is an intrathoracic malignancy with digital clubbing, symmetrical painful joint swelling and periosteal new bone formation along tubular bones. This represents secondary hypertrophic osteoarthropathy and is a recognised paraneoplastic manifestation of lung cancer. Rheumatoid arthritis can cause symmetrical wrist and ankle synovitis but does not explain clubbing or long-bone periostosis. Thyroid acropachy can produce clubbing and periosteal reaction, but it is rare and typically occurs with autoimmune thyroid disease, ophthalmopathy and dermopathy rather than lung cancer. Paget disease produces focal disorganised bone remodelling, while skeletal fluorosis causes diffuse osteosclerosis and ligamentous calcification rather than this characteristic clinicoradiographic triad.

Reference: Martínez-Lavín M. Hypertrophic osteoarthropathy. Best Practice & Research Clinical Rheumatology. 2020;34(3):101507. https://pubmed.ncbi.nlm.nih.gov/32291203/