摘要
Abstract
Objective To investigate the clinical manifestations of hypertrophic pulmonary osteoarthropathy(HPOA) with arthritis as the initial manifestation,and to raise the awareness and reduce misdiagnosis and mistreatment. Methods The clinical data of five HPOA patients,taking arthritis as the initial manifestation and receiving diagnosis and treatment in Beijing Jishuitan Hospital from 2006 to 2015,were retrospectively analyzed. The clinical manifestation,laboratory inspection and imaging characteristics were summarized combined with literature review. Results Clinical data:among the five patients,four male and one female,with a median age of 51 and the median course of disease of 6 months. Multiple joints of five cases were affected and presented symmetry,all of them had large joint of bilateral lower extremity affected(knee and ankle joints). Three had mild cough,and four had history of smoking. The five cases presented with visible clubbed fingers(toe). The primary disease of five patients was lung cancer. Laboratory examination:mild anemia occurred in three cases,erythrocyte sedimentation rate(ESR) and C - reactive protein( CRP)levels of four cases were increased,the rheumatoid factor( RF),anti - cyclic citrulline polypeptide(anti - CCP)antibody,antinuclear antibodies(ANAs)and human leukocyte antigen(HLA) - B27 of five cases were all negative,and levels of tumor markers of four cases were increased. Imaging:X - ray showed symmetrical periosteal reaction of both lower extremities(femur,tibia)in three cases,bone scintigraphy showed increased radioactive distribution of bone cortex of long bone of limbs in four cases,and lung CT of five cases found there were space - occupying lesions. Conclusion Although HPOA with the initial manifestation of arthritis is not commonly seen,when symmetrical arthritis of lower limbs,combining with clubbed fingers(toes),presence of systemic symptoms,poor anti - rheumatic treatment occur in middle aged and aged patients,X - ray and bone scanning should be performed actively,once the diagnosis of HPOA is made, pulmonary imaging should be improved for screening malignant tumors as early as possible.关键词
关节炎/肥大性肺性骨关节病/肺肿瘤Key words
Arthritis/Hypertrophic pulmonary osteoarthropathy/Lung neoplasma分类
医药卫生
