Chronic idiopathic osteoarthropathy.

Abstract

Clubbing of the fingers and hypertrophic osteoarthropathy, as different stages of the same process, are well recognized secondary phenomena in a variety of diseases involving different organ systems. This subject has been exhaustively reviewed by Mendlowitz (6). It is not so generally appreciated that clubbing with marked bone and joint changes may occur without demonstrable underlying primary disease. The American literature contains reports of 8 cases of idiopathic hypertrophic osteoarthropathy (1–5). The case to be reported here is believed to be the ninth to be described in this country. This patient has been followed for a period of six years, without evidence of significant progression of disability or the appearance of underlying disease. This would indicate the relative benignity and apparent idiopathic nature of the condition. Case Report A 29-year-old Negro soldier was seen in January 1953, complaining of intermittent pain in his lower legs, with recurrent swelling of the knees. He had first experienced pain in the knees and lower legs at the age of sixteen, and symptoms had become more severe recurring with increasing frequency, especially during the winter and in damp, inclement weather. Clubbing of the fingers and toes had been present as long as the patient could remember, and he had noted no marked change in degree over the years. He denied any skin changes or changes in facial appearance. Perspiration was not excessive. As a soldier during World War II he did fairly well while in th e warm, dry climate of the North African desert, but on being transferred t o Italy, in October 1943, he again became symptomatic. Since that time he had experienced recurrent difficulty with his ankles and knees. He was hospitalized in 1946 because of these symptoms and observed for possible rheumatoid arthritis, but no roentgenograms of the involved joints were obtained. Except for intermittent pain and swelling of the lower extremities, he had been in general good health and had been able to carry on his normal activities as an office worker. Between exacerbations of symptoms, he was completely well. In 1942 the patient had been hospitalized for eight weeks after a gunshot wound. There were no residua. In March 1947, he was again hospitalized, for hematuria of unknown cause. Examination, including intravenous and retrograde pyelography, was negative except for a congenital bifurcation of the left renal pelvis, which was considered to be of no clinical significance. There was no history of hereditary or familial clubbing. Roentgenograms of the mother's upper and lower extremities were negative. Physical examination showed a well developed colored male, 67 inches tall and weighing 150 pounds.