Primary Hypertrophic Osteoarthropathy-A Rare Cause of Joint Pain

A 48-year-old male displayed pain along with swelling of small joints of the hand and feet, along with low back pain, for the last 7-8 years. The joint pain was not associated with early morning stiffness or constitutional symptoms. On physical examination, all fingers and toes had bulbous enlargement and clubbing (Figs 1A and B). There were no skin changes and no motion restriction of any joint. Other systemic examination was normal. The routine investigations along with inflammatory markers and immunological tests were normal. A radiograph of bones showed periosteal changes in long bones as well as small bones of the hand and feet (Figs 1C to F) suggestive of hypertrophic osteoarthropathy (HOA). The patient was evaluated for secondary causes of HOA, and all his reports were within normal limits. The patient was diagnosed with incomplete primary hypertrophic osteoarthropathy (PHOA) on the basis of clinical and radiological features. The patient was given an infusion of 4 mg of zoledronic acid, along with etoricoxib, once daily. The patient responded to treatment with significant reduction in pain at 4 weeks and etoricoxib was stopped.