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HOA (Hypertrophic osteoarthropathy)


解説

HOAとは?

   1. chronic proliferative periostitis of long bones
   2. clubbing of fingers ,toes, or both
   3. oligosynovitis or polysinovitis              minimum: 1+2

  CLASSIFICATION
   Primary
    Pachydermoperiosteosis
    Idiopathic
    Clubbing (familial, Idiopathic)
   Secondary
    Pulmonary
     Neoplasm, Infection, IPF,pneumoconiosis,sarcoidosis…
    Cardiovascular
     SBE,CHD,PDA,aneurysm
    Gastrointestinal
     Neoplasm, Infection,hepatobiliary,IBD
    Neoplasms
    Thyroid
    Miscellaneous

  SIGN AND SYMPTOM
    Disease progression is often more rapid.
    The clinical manifestations of HOA may precede symptoms of the underlying associated
     disease by more than a year.
    The pain is sever in the distal extremities and is characteristically accentuated by
     dependency, relief of pain is achieved through elevation.
    There is often warmth and tenderness to presssure over the feet and legs, the distal tibia,
     the radius, and the ulna.
    Drinking worsens pain.
    Arthritis: stiffness, heat,swelling,sweating,edema  
     symmetric MP joint,wrist,elboe,knee,ankle,clavicle,tempromandibular

  LABORATORY FINDINGS
    ESR increse, complement normal, RF and ANA negative, ALP may be increased
    Synovial fluid is noninflammatory.

  RADIOGRAPHS
    Radiographic findings may occure in the absence of any clinical findings.
    Periosteal thickning occurs along the shafts of long and short bones.
    It appears less often in the phalanges.
    Scans demonstarates pericortical linear concentration of nuclide along the radial,
     femoral, and tibilal shafts along with periarticular uptake of the Radionuclide ,
     emphasizing the presence of synovitis.
    

  DIFFERENTIAL DIAGNOSIS
    Whenever HOA is diagnosed, it is crucial to search for an associated disease.
     Isolated clubbing
      prodrome of HOA or may represent a separate entity.(表)
     Periostitis
      Bone tumor, osteomyelitis, subperiosteal hemorrhage, juvenile RA
      syphilis, lymphangitis, scurvy, Vitamin A toxicity
     Polyarthritis
      RA and other collagen diseases, carcinomatous polyarthritis

  PATHOLOGY
    Subperiosteal cancellous new bone formation.
    Pathologic fractures occur uncommonly.

  ETIOLOGY
    Unknown

  MANAGEMENT
    treatment of the underlying condition.
    Vagotomy
    NSAIDs
    Steroid



表  続発性HOAの原因疾患

  1. 呼吸器疾患
      原発性肺癌
      胸膜腫瘍
      縦隔腫瘍
      転移性胸腔内腫瘍 肺膿瘍
      気管支拡張症
      慢性気管支炎
      カリニ肺炎
      間質性肺炎
      塵肺症
      肺結核症
      サルコイドーシス
      縦隔内Hodgkin病
  2. 心血管疾患
      チアノーゼ性CHD
      感染性心内膜炎
      心横紋筋肉腫
      大動脈瘤
      動脈管開存症
  3. 消化器疾患
      潰瘍性大腸炎
      クローン病
      アメーバ性腸炎
      横隔膜下膿瘍
      特発性脂肪便
      スプルー
      小腸腫瘍
      大腸腫瘍
      多発大腸ポリープ
      肝硬変肝腫瘍
      原発性胆管性肝硬変肝アミロイドーシス
      胆道閉塞症
  4. 内分泌疾患
      甲状腺切除術後
      甲状腺機能亢進症
      副甲状腺機能亢進症   
  5. その他
      下剤常用者、妊娠



CLASSIFICATION OF POLYARTHRITIS
  INFLAMMATORY
    Peripheral polyarticular
      RA
      SLE
      Viral arthritis
      Psoriatic arthritis
    Peripheral pauciarticular
      Psoriatic arthritis
      Reiter's syndrome
      Rheumatic fever
      Polyarticular gout
      Enteropathic arthritis
      Behcet's disesae
      Bacterial endocarditis
      Peripheral with axial involvement
      Ankylosing spondylitis
      Reiter's syndrome
      Enteropathic arthritis
      Psoriatic arthritis

  NONINFLAMMATORY

    Hereditary
      Osteoarthritis of the hands
      Primary generalized osteoarthritis
    Traumatic osteoarthritis
    Metabolic diseases
      Hemochromatosis
      Ochronosis
      Acromegaly

PARANEOPLASTIC SYNDROMES
1. Myopathy, Scleroderma
2. HOA, Polyarteritis, Amyloidosis, PMR, Secondary gout, Panniculitis, Carcinoma polyarthritis, Polycondritis, Jaccoud's type arthropathy, Lupus antibody syndrome, Miscellaneous arthropathies, Pyogenic arthritis
3. Miscellaneous Presentations, Osteomalacia, Lupus-like syndrome, Digital necrosis, Necrotizing vasculitis, Erythromelalgia, Cryoproteins, Antiphospolipid antibody syndrome, Immune complex disease, RSD

FEATURES OF CARCINOMA POLYARTHRITIS
   Asymmetric joint involvement
   Explosive onset
   Predominant lower extremity involvement with sparing of wrists and small joints
   No periosteal reaction
   Late age at onset of arthritis
   Abscence of RAF, rheumatoid nodules
   Nonspecific histopathologic appearance of synovial lining





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