Ivo Jajić

English

Jajić, Ivo

Hrčak - Portal of scientific journals of Croatia

Acta clin Croat 2000; 39:191-192 Letter to the Editor191NAILS “OBSTRUCTING” FINGER GROWTH IN LENGTH INPRIMARY HYPERTROPHIC OSTEOARTHROPATHYSir,During the 1970 · 1996 period, we made the diagnosis ofprimary hypertrophic osteoarthropathy (PHO) in 76 patients,five (6.5%) women and 71 (93.5%) men1. The patients wereaged 15-72 years, mean age 41.5 (SD = 10.23) years. Accord-ingly, they were at the age when the formation of finger club-bing was completed. They all had finger clubbing. In all patients,clinical, laboratory, scintigraphic, radiologic and other tests ex-cluded the possible existence of secondary hypertrophic osteoar-thropathy (SHO). In addition, the characteristics of nails andfinger clubbing were examined in all patients. The nails wereconvexly curved in longitudinal and transverse direction, resem-bling the glass on the watch2. Some nails such as the nails ofthe second and fifth fingers were even more curved, also hav-ing a greater surface3. The nail of the second finger grew overthe tip of the finger toward the palmar side, so that the termi-nal phalanx of the finger could not develop anymore. The con-vexity of all fingers developed from the distal interphalangealjoint (DIP) toward the free end of the nail (Fig. 1). In the de-velopment of a clubbed finger in PHO, usually in adolescence,the nail is more firmly fixed and cannot be pressed toward thesurface. In SHO, the nails grow very rapidly depending on theactivity of the underlying disease (e.g., bronchogenic carcinoma,mediastinal carcinoma, etc.), have a smooth and glossy surface,occasionally developing folds and white spots, particularly in theelderly. In PHO, the nails grow rapidly until adolescence, thenslowly to a certain limit when they terminate their growth andacquire a definite form. The finger continues growing while thenail stops its growth earlier and develops in a wrong direction,becoming curved on the tip of the finger. Consequently, thefingers are extended, especially the terminal ends of the fingersand toes, resembling a paw or ball. DIP joints become hyper-extended. These are so-called bulb forms of fingers that developdue to the ‘obstructing’ growth in length and swelling of theconnective tissue on the finger tip. Bulb fingers rarely developunilaterally4, and so do also changes of the nails which cause nodiscomforts. However, in the active stage of disease (both SHOand PHO), erythema around the nails and telangiectasia, per-spiration and warmth are pronounced. Vasodilatation and en-hanced blood circulation occur in the distal end of the finger,whatever the etiopathogenesis of disease (growth factor, pros-taglandins, tissue hypoxia, neurogenic reflection, genetic factors,growth hormone, tumor necrosis factor, etc.). This leads to tis-sue swelling and growth of the terminal segment of distal pha-lanx until the curving nail, growing in all directions, stops thefinger growth in length5-12. That is why the finger acquires theclubbed shape. In conclusion, the nails ‘obstructing’ fingergrowth in length are an important feature of PHO.Professor Ivo JajiÊ, M.D., Ph.D.Department of Rheumatology,Physical Medicine and Rehabilitation,Reference Center for Inflammatory Rheumatic Diseases,Sestre milosrdnice University Hospital, Zagreb, CroatiaReferences1. JAJIÆ I, JAJIÆ Z. Hypertrophic osteoarthropathy. Zagreb: Medi-cinska knjiga, 1997:1-170.2. FISCHER DS, SINGER DH, FELMAN SM. Clubbing · a re-view with emphasis on hereditary acropathy. Medicine 1964;43:459.3. MATUCCI-CERINIC M, LOTTI T, JAJIÆ I et al. The clinicalspectrum of pachydermatoperiostosis (primary hypertrophic osteo-arthropathy). Medicine 1991;70:208.4. KAHTAN S, KAHTAN N. Unilateral finger clubbing. Lancet1991;338:576.5. DICKINSON CJ, MARTIN JF. Megakaryocytes and plateletclumps as the cause of finger clubbing. Lancet 1987;2:1434-5.6. BALK SD, WHITFIELD JF, YOUDALE T et al. Roles of cal-cium, serum, plasma and folic acid in the control of proliferationI. JajiÊ Letter to the Editor192 Acta clin Croat, Vol. 39, No. 3, 2000of normal and Rous sarcoma virus-infected chicken fibroblasts.Proc Natl Acad Sci USA 1993;70:675-9.7. HUANG JS, HUANG SS, KENNEDY E et al. Platelet derivedgrowth factor. Specific binding to target cells. J Biol Chem1982;257:8130-6.8. LOWELL RRH. Observations on the structure of clubbed fingers.Clin Sci 1950;9:299-321.9. MATUCCI-CERINIC M, CINTI S, MARRONI M et al.Pachydermatoperiostosis (primary hypertrophic osteoarthropathy):report of a case with evidence of endothelial and connective tissueinvolvement. Ann Rheum Dis 1989;48:240-6.10. MATUCCI-CERINIC M, LOTTI T, JAJIÆ I et al. Cutaneousfibrinolytic activity in primary hypertrophic osteoarthropathy.Scand J Rheumatol 1987;10:205-12.11. DUPONT B, HOYER I, BORGESKOV S, NERUP J. Plasmagrowth hormone and hypertrophic osteoarthropathy in carcinomaof the bronchus. Acta Med Scand 1970;188:25-30.12. LEMEN RJ, GATES AJ, MATHE AA et al. Relationship amongdigital clubbing, disease severity and serum prostaglandins F2a andF concentration in cystic fibrosis patients. Am Rev Respir Dis1978;117:639-42.

Nails “Obstructing” Finger Growth in Length in Primary Hypertrophic Osteoarthropathy

Abstract

Similar works

Full text

Available Versions

Hrčak - Portal of scientific journals of Croatia