ArtsAutosBooksBusinessEducationEntertainmentFamilyFashionFoodGamesGenderHealthHolidaysHomeHubPagesPersonal FinancePetsPoliticsReligionSportsTechnologyTravel

Clinical Significance Of Other Bone Diseases: Hypertrophic Osteoarthropathy And Paget’s Disease Of Bone

Updated on February 13, 2014

Hypertrophic Osteoarthropathy Clear manifestation

Source

Hypertrophic Osteoarthropathy In Its Physical Presentation

Source

Hypertrophic Osteoarthropathy

Also known as hypertrophic pulmonary osteoarthropathy, Marie-Bamberger’s syndrome etc, is an acquired disorder characterized by clubbing of the fingers and toes, painful thickening of the ends of long bones such as the tibia and radius and varying degrees of arthritis. In most cases, it is secondary to other underlying disorders, rarely it may be idiopathic and at times it runs in families. The exact mechanism of development of the lesions is not clear.

Causes

Pulmonary lesions: Chronic suppuration such as bronchiectasis, lung abscess and empyema, carcinoma lung, pleural mesothelioma, alveolo-capillary block syndromes, fungal infections and chronic fibroid tuberculosis.

Cardiovascular lesions: Cyanotic congenital heart disease, infective endocarditis, aneurysm of the Aorta or its branches.

Other conditions: Chronic malabsorption states, ulcerative colitis, regional ileitis, cirrhosis liver, hepatic abscess and thyrotoxicosis.

Clinical Features

Onset is very insidious in the vast majority of cases, but it is rapid in malignancy of the lung or pleura and infective endocarditis. It is usually bilateral but unilateral clubbing may develop in aneurysm of the subclavian artery. The manifestations include clubbing of the fingers and toes, symmetrical painful enlargement of distal ends of bones at the wrist and ankle and intermittent swelling and painful limitation of joint movements. In a few cases, true arthritis, fibrous ankylosis and deformity may result.

When hypertrophic osteoarthropathy is associated with marked thickening of the skin of the limbs and face, this is called pachydermoperiostosis.

Management

In all secondary cases, the primary cause should be detected and corrected. This leads to resolution of the bone changes. Nonsteroidal anti-inflammtory drugs relieve pain.

Paget's Disease Of The Bone

Source

Osteitis Deformans

Source

Paget’s Disease Of Bone (Osteitis Deformans)

This is a rare disease of unknown etiology, characterized by enlargement, softening and deformity of several bones, seen after the age of 40 years, more commonly in men. Though, this disease is common in the west, it is seen only rarely in Indians especially. The involvement is localized in the majority of cases but may be widespread.

Pathology: There is increased formation and destruction of bone which is disorderly. This results in a high rate of bone turnover. The bone is highly vascular and functional arteriovenous shunts develop, resulting in a high cardiac output state. The marrow is replaced by highly vascular fibrous tissue. Pelvis, femur, skull, tibia, and vertebrae are affected in the order of frequency.

Clinical Features

Many cases are asymptomatic and detected on routine radiological examination. Symptoms include pain on weight bearing, progressive enlargement of the skull, deformities of the affected bones, pressure on the nerves which can pass through bony canals (Cranial nerves, spinal nerves and spinal cord) and rarely the development of high output cardiac failure state. Though the bones are thickened, they are weaker than normal. The femur and tibia undergo bowing and other deformities due to weight- bearing. The overlying skin is warm due to increased vascularity. Deafness, optic atrophy, and paraplegia are rare neurological complications. Serum alkaline phosphatase is grossly elevated. Serum Calcium and phosphorus are normal. Urinary hydoxyproline is increased during the active phase of the disease.

Complications: These include fracture, progressive deformity, cranial nerve palsies (especially deafness), spinal cord compression, degenerative joint disease, high output cardiac failure when the diease is extensive and in longstanding cases, osteogenic sarcoma.

Diagnosis: The diagnosis is based on clinical features and is confirmed by radiography. The bones appear larger, chalky white and non-homogenous in the skiagram.

Treatment: Asymptomatic localized lesions have to be left alone. Symptomatic relief of pain is achieved by aspirin, indomethacin or corticosteroids. Human calcitonin in a dailu dose of 0.5 mg subcutaneously for 6 months (or salmon calcitonin 100 MRC units/day) promptly relieves bone pains and helps in reducing the turnover of bone. Mitrhamycin in a dose of 25- 50 ug/Kg given intravenously for 10- 14 days is effective. This drug inhibits bone resorption. It produces myelosuppression and a hemorrhagic tendency. Diphosphonates (disodium etidronate) in a dose of 5- 10 mg/Kg/day also reduced bone turnover and bring about clinical relief in some cases. However, they are less effective than calcitonin. Calcitonin and etidronate can be combined.

Immobilization should be avoided since it leads to hypercalcemia and hypercalciuria. The onsent of osteogenic sarcoma should be looked for in longstanding cases.

© 2014 Funom Theophilus Makama

Comments

    0 of 8192 characters used
    Post Comment

    No comments yet.

    working

    This website uses cookies

    As a user in the EEA, your approval is needed on a few things. To provide a better website experience, hubpages.com uses cookies (and other similar technologies) and may collect, process, and share personal data. Please choose which areas of our service you consent to our doing so.

    For more information on managing or withdrawing consents and how we handle data, visit our Privacy Policy at: https://hubpages.com/privacy-policy#gdpr

    Show Details
    Necessary
    HubPages Device IDThis is used to identify particular browsers or devices when the access the service, and is used for security reasons.
    LoginThis is necessary to sign in to the HubPages Service.
    Google RecaptchaThis is used to prevent bots and spam. (Privacy Policy)
    AkismetThis is used to detect comment spam. (Privacy Policy)
    HubPages Google AnalyticsThis is used to provide data on traffic to our website, all personally identifyable data is anonymized. (Privacy Policy)
    HubPages Traffic PixelThis is used to collect data on traffic to articles and other pages on our site. Unless you are signed in to a HubPages account, all personally identifiable information is anonymized.
    Amazon Web ServicesThis is a cloud services platform that we used to host our service. (Privacy Policy)
    CloudflareThis is a cloud CDN service that we use to efficiently deliver files required for our service to operate such as javascript, cascading style sheets, images, and videos. (Privacy Policy)
    Google Hosted LibrariesJavascript software libraries such as jQuery are loaded at endpoints on the googleapis.com or gstatic.com domains, for performance and efficiency reasons. (Privacy Policy)
    Features
    Google Custom SearchThis is feature allows you to search the site. (Privacy Policy)
    Google MapsSome articles have Google Maps embedded in them. (Privacy Policy)
    Google ChartsThis is used to display charts and graphs on articles and the author center. (Privacy Policy)
    Google AdSense Host APIThis service allows you to sign up for or associate a Google AdSense account with HubPages, so that you can earn money from ads on your articles. No data is shared unless you engage with this feature. (Privacy Policy)
    Google YouTubeSome articles have YouTube videos embedded in them. (Privacy Policy)
    VimeoSome articles have Vimeo videos embedded in them. (Privacy Policy)
    PaypalThis is used for a registered author who enrolls in the HubPages Earnings program and requests to be paid via PayPal. No data is shared with Paypal unless you engage with this feature. (Privacy Policy)
    Facebook LoginYou can use this to streamline signing up for, or signing in to your Hubpages account. No data is shared with Facebook unless you engage with this feature. (Privacy Policy)
    MavenThis supports the Maven widget and search functionality. (Privacy Policy)
    Marketing
    Google AdSenseThis is an ad network. (Privacy Policy)
    Google DoubleClickGoogle provides ad serving technology and runs an ad network. (Privacy Policy)
    Index ExchangeThis is an ad network. (Privacy Policy)
    SovrnThis is an ad network. (Privacy Policy)
    Facebook AdsThis is an ad network. (Privacy Policy)
    Amazon Unified Ad MarketplaceThis is an ad network. (Privacy Policy)
    AppNexusThis is an ad network. (Privacy Policy)
    OpenxThis is an ad network. (Privacy Policy)
    Rubicon ProjectThis is an ad network. (Privacy Policy)
    TripleLiftThis is an ad network. (Privacy Policy)
    Say MediaWe partner with Say Media to deliver ad campaigns on our sites. (Privacy Policy)
    Remarketing PixelsWe may use remarketing pixels from advertising networks such as Google AdWords, Bing Ads, and Facebook in order to advertise the HubPages Service to people that have visited our sites.
    Conversion Tracking PixelsWe may use conversion tracking pixels from advertising networks such as Google AdWords, Bing Ads, and Facebook in order to identify when an advertisement has successfully resulted in the desired action, such as signing up for the HubPages Service or publishing an article on the HubPages Service.
    Statistics
    Author Google AnalyticsThis is used to provide traffic data and reports to the authors of articles on the HubPages Service. (Privacy Policy)
    ComscoreComScore is a media measurement and analytics company providing marketing data and analytics to enterprises, media and advertising agencies, and publishers. Non-consent will result in ComScore only processing obfuscated personal data. (Privacy Policy)
    Amazon Tracking PixelSome articles display amazon products as part of the Amazon Affiliate program, this pixel provides traffic statistics for those products (Privacy Policy)