J Bone Metab.  2014 May;21(2):151-154. 10.11005/jbm.2014.21.2.151.

Hypertrophic Osteoarthropathy in Patient with Crohn's Disease: A Case Report

• Rhee SM
• Park KJ
• Ha YC

• KMID: 2241536
• DOI: http://doi.org/10.11005/jbm.2014.21.2.151

Abstract

Numerous causes of hypertrophic osteoarthropathy (HOA) have been reported. Commonly, secondary osteoarthropathy accompanies pulmonary diseases such as carcinoma of the lung, pleural tumors, lung abscesses, and bronchiectasis. However, HOA in inflammatory bowel disease is a rare complication. There are only a few reports of secondary HOA with Crohn's disease. Our purpose was to report another case of HOA in Crohn's disease. We describe a case of a 27-year-old man with underlying Crohn's disease presenting with 2 years of pain in multiple joints. Radiographic findings suggested HOA in extremities. We performed a conservative treatment including medication and rehabilitations. The patient's symptoms were much improved at the latest follow-up. Although numerous studies on HOA have been published, the pathogenesis of HOA is still unclear. Various treatment modalities were recommended but further studies to uncover the pathogenesis of HOA with Crohn's disease and to establish a treatment modality are needed.

Keyword

Crohn's disease; Hypertrophic osteoarthropathy; Periostitis

MeSH Terms

Adult
Bronchiectasis
Crohn Disease*
Extremities
Follow-Up Studies
Humans
Inflammatory Bowel Diseases
Joints
Lung
Lung Abscess
Lung Diseases
Periostitis

Figure

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  Fig. 1 Entire bone series X-ray (A) and fine focus magnification of the tibia and femur (B) show thick and wavy periosteal reaction involving metaphysis and diaphysis of long bones including both femurs, tibias and fibulas, sparing the epiphysis. Also seen is multilayered periostitis in both tibias which suggests disease progression.

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  Fig. 2 Both hand anteroposterior radiographs demonstrate bilateral symmetric metaphyseal and diaphyseal thick periosteal reactions in both distal radius and ulna. We can also see smooth cortical thickening in diaphysis of both 1st, 2nd, and 3rd metacarpal bones.

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  Fig. 3 A nuclear medicine 99mTc-hydroxymethane diphosphonate bone scan revealed bilateral symmetrical cortical uptake in both distal femurs, tibias and fibulas.

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