Acro-osteolysis

Abstract

A 71-year-old man hospitalised with tracheobronchitis, complained of hand discolouration. His hands showed the three-phases of skin colour changes (white, blue, and red) and a diagnosis of Raynaud's syndrome was established. When questioned about the first time he had these symptoms, the patient noted that they had been recurrent for about 20 years. He had relatively short fingers, particularly of the thumbs, and no bone was palpable in most of the distal phalanges (figure A). Radiography of his hands showed bone resorption of almost all terminal phalanges of both hands, so-called acro-osteolysis (figure B). Immunological investigations and clinical features excluded several diseases commonly associated with Raynaud's syndrome. Nailfold capillaroscopy was done and showed no changes, supporting the diagnosis of primary Raynaud's syndrome. The most common causes of acro-osteolysis include scleroderma, psoriatic arthritis, occupational causes, injury (eg, thermal burn), and hereditary syndromes (eg, Hadju-Cheney syndrome). In patients with long-standing primary Raynaud's syndrome, chronic vascular deficiency may lead to acro-osteolysis. A 71-year-old man hospitalised with tracheobronchitis, complained of hand discolouration. His hands showed the three-phases of skin colour changes (white, blue, and red) and a diagnosis of Raynaud's syndrome was established. When questioned about the first time he had these symptoms, the patient noted that they had been recurrent for about 20 years. He had relatively short fingers, particularly of the thumbs, and no bone was palpable in most of the distal phalanges (figure A). Radiography of his hands showed bone resorption of almost all terminal phalanges of both hands, so-called acro-osteolysis (figure B). Immunological investigations and clinical features excluded several diseases commonly associated with Raynaud's syndrome. Nailfold capillaroscopy was done and showed no changes, supporting the diagnosis of primary Raynaud's syndrome. The most common causes of acro-osteolysis include scleroderma, psoriatic arthritis, occupational causes, injury (eg, thermal burn), and hereditary syndromes (eg, Hadju-Cheney syndrome). In patients with long-standing primary Raynaud's syndrome, chronic vascular deficiency may lead to acro-osteolysis.