Clubbing and hypertrophic osteoarthropathy: insights in diagnosis, pathophysiology, and clinical significance. Issue 3 (3rd May 2016)

• Record Type: Journal Article
• Authors: Callemeyn, Jasper; Van Haecke, Peter; Peetermans, Willy E.; Blockmans, Daniel
• Is Part Of: Acta clinica belgica. Volume 71:Issue 3(2016)
• Page Start: 123
• Page End: 130
• Publication Date: 2016-05-03
• Subjects: Digital clubbing -- Osteoarthropathy -- Secondary hypertrophic -- Vascular endothelial growth factor -- Lung cancer -- Algorithm; Clinical medicine -- Periodicals; Diagnosis, Laboratory -- Periodicals; 616.005
• DOI: 10.1080/17843286.2016.1152672
• Languages: English
• ISSNs: 1784-3286

Abstract

Abstract : Background : Digital clubbing and hypertrophic osteoarthropathy (HOA) form a diagnostic challenge. Subtle presentations of clubbing are often missed. The underlying pathophysiology remains unclear. Establishing a differential diagnosis based on nonspecific signs can be cumbersome. Finally, the prognostic value of clubbing and HOA remains unclear. Objective: This article reviews clinical criteria and pathophysiology of clubbing and HOA. A diagnostic algorithm is proposed, based on etiology and current insights. The prognostic impact on associated diseases is discussed. Methods: The Internet databases Medline and Embase were searched. Articles were selected based on relevance of abstract, article type and impact of the journal. Results: Diagnostic criteria include Lovibond's profile sign, distal/interphalangeal depth ratio and Schamroth's sign. Three pathophysiological causes of clubbing can be distinguished: hypoxia, chronic inflammation and aberrant vascularization. A prominent role for vascular endothelial growth factor is suggested. Associated symptoms and clinical signs should guide the initial diagnostic evaluation. Finally, clubbing is a negative prognostic factor in certain pulmonary disorders, including cystic fibrosis.