Periostitis in hypertrophic osteoarthropathy: relationship to disease duration

The relationship of periostitis to disease duration in primary hypertrophic osteoarthropathy and the association of periostitis with cardiopulmonary disorders (secondary type) were studied in order to define distinguishing features between the two. Radiographic skeletal surveys were performed in 24 patients with hypertrophic osteoarthropathy to analyze pattern (single layer, multilayered, irregular) and site of involvement (diaphysis, metaphysis, epiphysis). The six patients with primary hypertrophic osteoarthropathy and the 11 patients with cyanotic congenital heart disease had thicker, more widespread periostitis involving the diaphysis, metaphysis, and epiphysis, in contrast to abnormalities in the seven patients with hypertrophic osteoarthropathy secondary to carcinoma of the lung. Average cortical bone widths as determined by radiogrammetric measurement of the second metacarpals were significantly greater for the patients with primary hypertrophic osteoarthropathy (8.9 +/- 6.0 mm) and cyanotic congenital heart disease (8.5 +/- 6.4 mm) as compared with the patients with bronchogenic carcinoma (6.0 +/- 3.9 mm). Correlation of radiographic patterns with duration of disease confirms that thicker, more extensive alterations are indicative of long-standing disease. The periostitis of hypertrophic osteoarthropathy is therefore not dependent on the primary or secondary nature of the disease but principally on its duration.