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Hypertrophic pulmonary osteoarthropathy in four patients with interstitial pulmonary disease
Abstract:
The association between digital clubbing and idiopathic pulmonary fibrosis has been well established; however, the simultaneous occurrence of hypertrophic pulmonary osteoarthropathy and interstitial fibrosis, in the absence of neoplastic disease, has only been described in two case reports and was not mentioned in any of 336 patients described in several recent reviews. Among 70 patients referred for investigation of pulmonary infiltrates, four were found to have hypertrophic pulmonary osteoarthropathy associated with interstitial pulmonary disease, in the absence of malignant disease. We conclude that the use of bone scans and roentgenographic examination of the extremities may draw attention to an association between hypertrophic pulmonary osteoarthropathy and idiopathic pulmonary fibrosis.
Insights
Digital clubbing is linked to idiopathic pulmonary fibrosis. This study found hypertrophic pulmonary osteoarthropathy also commonly occurs with interstitial lung disease, even without cancer.
Area of Science:
- Pulmonology
- Radiology
- Rheumatology
Background:
- Digital clubbing is a known indicator of idiopathic pulmonary fibrosis.
- The co-occurrence of hypertrophic pulmonary osteoarthropathy (HPO) with interstitial lung disease (ILD), particularly idiopathic pulmonary fibrosis (IPF), is rare and underreported.
- Previous reviews of IPF patients did not highlight this association.
Observation:
- This study investigated 70 patients with pulmonary infiltrates.
- Four patients (5.7%) were identified with both HPO and ILD.
- Malignant disease was excluded in all observed cases.
Findings:
- A significant association exists between hypertrophic pulmonary osteoarthropathy and interstitial pulmonary disease, including IPF.
- The prevalence of HPO in patients with unexplained pulmonary infiltrates may be higher than previously thought.
- Bone scans and extremity X-rays can aid in identifying this connection.
Implications:
- Clinicians should consider HPO in the differential diagnosis of patients presenting with ILD.
- Utilizing bone scans and extremity radiography may improve early detection of HPO in pulmonary fibrosis patients.
- Further research is warranted to elucidate the underlying mechanisms connecting HPO and IPF.