Hypertrophic osteoarthropathy represents a disease that occurs in only a small number of individuals. In hypertrophic osteoarthropathy, sections on the diaphyses in the area of the long tubular bones on the limbs swell. The areas affected by the swellings cause pain. In addition, the toes and fingers of patients suffering from hypertrophic osteoarthropathy widen.
What is hypertrophic osteoarthropathy?
Hypertrophic osteoarthropathy primarily affects the diaphyses around the extremities. In addition, some of the affected individuals develop additional joint symptoms. The motor function of the feet and hands of the affected persons may also be disturbed. More rarely, neurovegetative impairments and the development of a so-called dysproteinemia have been observed in connection with hypertrophic osteoarthropathy. In general, male patients are more often affected by hypertrophic osteoarthropathy than females. In most cases, the patients are in middle age. A variety of different synonymous disease names exist for hypertrophic osteoarthropathy. For example, the disease is also called Marie-Bamberger syndrome, Pierre-Marie disease, or osteoperiostitis ossificans toxicans. The first person to describe the disease was Bamberger, who intensively studied hypertrophic osteoarthropathy in 1889. In the process, the physician already discovered that a connection existed between widened toes and fingers and diseases of the heart or lungs. A year later, in 1890, Doctor Marie clearly distinguished hypertrophic osteoarthropathy from the so-called acromegaly.
Causes
In principle, various causes exist for the development of hypertrophic osteoarthropathy. In the majority of cases, the disease is triggered by a so-called paraneoplastic syndrome. This type of syndrome may occur together with a carcinoma of the bronchial tubes, which is usually a non-small cell carcinoma. In addition, hypertrophic osteoarthropathy occurs clustered with various other diseases. These include, for example, chronic diseases of the heart or lungs, such as pulmonary fibrosis or cystic fibrosis. Hypertrophic osteoarthropathy also sometimes occurs in the context of bronchiectasis. In addition, the disease sometimes develops in parallel with various diseases of the liver associated with dysproteinemia. Finally, in some patients there is an association with Crohn’s disease. Research into the causative factors for the development of hypertrophic osteoarthropathy shows that the disease is rather rarely concentrated in certain families of patients. This fact is rather less indicative of a distinct genetic component of hypertrophic osteoarthropathy. In some cases, hypertrophic osteoarthropathy is also triggered by tumors in the lung. In addition, this type of tumor often occurs together with carcinomas of the bronchi.
Symptoms, complaints, and signs
Hypertrophic osteoarthropathy manifests itself in a number of typical complaints that occur in the majority of affected patients. For example, swelling develops as part of the disease, from which pain emanates. In some cases, the affected areas suffer from circulatory disorders. The swellings develop primarily on the long tubular bones and there mainly on the so-called diaphyses. In addition, the toes and fingers of those suffering from hypertrophic osteoarthropathy widen noticeably. Timely diagnosis of hypertrophic osteoarthropathy is of enormous importance. This is because in some cases the disease is associated with bronchial carcinoma, which leads to the corresponding symptoms. If the symptoms of hypertrophic osteoarthropathy are recognized at an early stage, early diagnosis of the carcinoma is possible. In this way, valuable time can be gained and therapy can be started sooner.
Diagnosis and disease progression
To diagnose hypertrophic osteoarthropathy, the cooperation of the affected patient is required. Thus, if typical symptoms of the disease appear, a physician should be informed quickly to make a diagnosis.This usually begins with the anamnesis, in the course of which he asks the patient about the complaints, their onset and circumstances of origin, as well as the general lifestyle. In this way, the physician tries to gather significant clues to identify the disease at hand and to make a tentative diagnosis. The suspicions are substantiated in the second step of establishing the diagnosis, the clinical examination of the patient. Here, the main focus is on the physical examination of the sick person. Typical changes in the appearance of the toes and fingers, in conjunction with the pain described, clearly indicate hypertrophic osteoarthropathy. Before the diagnosis is considered confirmed, a conscientious differential diagnosis must be carried out. In doing so, the physician tries to distinguish the complaints from chronic diseases of the lungs, such as bronchiectasis or tuberculosis. Inflammatory diseases of the intestine with a chronic course must also be ruled out. The physician also checks for the possible presence of liver cirrhosis.
Complications
The primary complication of this disease is severe swelling, which in most cases is also associated with pain. These swellings can lead to various restrictions in the movement and everyday life of the affected person. The pain can also occur in the form of pain at rest, leading to sleep problems. Blood circulation is weakened, so that extremities are cold or become paralyzed. In the worst case, certain regions can die off completely. Further complications usually occur when a carcinoma is diagnosed late and has already spread to other regions. In this case, the life expectancy of the patient is extremely reduced. Treatment is usually causal and depends on the underlying disease. However, the course of the disease is not positive in every case. However, the further sale of the disease depends on the underlying disease and its progress. In many cases there are also psychological complaints, so that treatment by a psychologist is also necessary. With an early diagnosis and treatment, however, the complaints can be well limited.
When should you see a doctor?
Hypertrophic osteoarthropathy is a condition that must be treated by a physician for relief of symptoms to occur. Swelling in the limbs or throughout the body is a sign of irregularities as well as the presence of a disorder. If pain also occurs, the affected person needs medical care. Pain medication should generally only be taken in consultation with a medical professional, as serious side effects can occur. If mobility is restricted and the joints can no longer be moved or loaded as usual, a doctor is needed. Without treatment, the changes in mobility can lead to serious consequences and lifelong impairments. If the affected person notices disturbances of the blood circulation, a clarification of the complaints by a physician is necessary. If there are cold fingers or toes, a feeling of pressure on the body or discoloration of the skin, a doctor should be consulted. If heart palpitations, dizziness or nausea set in, an examination should take place. If the toes or fingers widen, action is required. The visual changes indicate a disease that needs to be treated. Sleep disturbances or psychological impairments are further indications that should be investigated. If the symptoms persist for several weeks or months, a follow-up visit to a doctor is therefore advisable.
Treatment and therapy
Treatment of hypertrophic osteoarthropathy depends primarily on the underlying disease. Prompt therapy of the underlying disease is very important in the majority of cases, as these are often serious conditions. The pain that occurs in hypertrophic osteoarthropathy is often treated with nonsteroidal anti-inflammatory agents.
Prevention
Because prevention of hypertrophic osteoarthropathy addresses the underlying disease in particular, effective prevention is difficult in practice.
Follow-up
Follow-up care of hypertrophic osteoarthropathy often leads to a change in usual routines and therefore amounts to self-help measures.The symptoms can be alleviated by accompanying measures, which has a positive effect on the patient’s quality of life. There are various self-help options, which the doctor explains in direct conversation with the affected person. The typical swelling in the foot area and often in other parts of the body causes pain. These are reduced by taking the appropriate medication. Patients should follow the doctor’s instructions for these medications exactly in order to avoid overdosing. Special footwear with orthopedic properties also helps against foot pain. The orthopedist adapts this to the individual needs. The special shoes improve the mobility of those affected. Nevertheless, it is impossible to avoid a decrease in sporting activities. However, patients should make sure that they do not give up activities completely. Physical exercise is good for them, even if the extent is reduced. With the help of a physiotherapist, an individual exercise program is created that patients can carry out themselves after receiving detailed instructions. The exercises improve their fitness and make them feel better. This has a positive effect on their overall condition and increases their quality of life.
Here’s what you can do yourself
Patients with hypertrophic osteoarthropathy are usually restricted in their usual everyday life as well as their quality of life by the accompanying symptoms. By means of suitable self-help measures, those affected improve their individual well-being, although medical care always plays an important role. The swellings in the feet and other parts of the body often cause pain, so patients take appropriate medication prescribed by a specialist. Orthopedic footwear, individually adapted to the patient’s altered foot, contributes to the patient’s continued ability to move. Sports activities often have to be limited because of hypertrophic osteoarthropathy, but not completely abandoned. This is because a certain amount of physical activity supports the general state of health as well as the well-being of patients with Hypertrophic Osteoarthropathy. A physiotherapist works with the patient to develop suitable exercise routines, which the patient can also perform independently at home, thereby increasing or at least maintaining his or her physical fitness. Generally, an underlying disease causes hypertrophic osteoarthropathy, which must be diagnosed. As long as this has not been done, patients adhere to a healthy lifestyle agreed with the specialist with regard to diet, exercise and the consumption of stimulants. In this way, it is possible in some cases to have a positive influence even on the underlying disease, which is still unknown.
