SIGN AND SYMPTOM
Disease progression is often more rapid.
The clinical manifestations of HOA may precede symptoms of the underlying associated
disease by more than a year.
The pain is sever in the distal extremities and is characteristically accentuated by
dependency, relief of pain is achieved through elevation.
There is often warmth and tenderness to presssure over the feet and legs, the distal tibia,
the radius, and the ulna.
Drinking worsens pain.
Arthritis: stiffness, heat,swelling,sweating,edema
symmetric MP joint,wrist,elboe,knee,ankle,clavicle,tempromandibular
LABORATORY FINDINGS
ESR increse, complement normal, RF and ANA negative, ALP may be increased
Synovial fluid is noninflammatory.
RADIOGRAPHS
Radiographic findings may occure in the absence of any clinical findings.
Periosteal thickning occurs along the shafts of long and short bones.
It appears less often in the phalanges.
Scans demonstarates pericortical linear concentration of nuclide along the radial,
femoral, and tibilal shafts along with periarticular uptake of the Radionuclide ,
emphasizing the presence of synovitis.
DIFFERENTIAL DIAGNOSIS
Whenever HOA is diagnosed, it is crucial to search for an associated disease.
Isolated clubbing
prodrome of HOA or may represent a separate entity.（表）
Periostitis
Bone tumor, osteomyelitis, subperiosteal hemorrhage, juvenile RA
syphilis, lymphangitis, scurvy, Vitamin A toxicity
Polyarthritis
RA and other collagen diseases, carcinomatous polyarthritis
PATHOLOGY
Subperiosteal cancellous new bone formation.
Pathologic fractures occur uncommonly.
ETIOLOGY
Unknown
MANAGEMENT
treatment of the underlying condition.
Vagotomy
NSAIDs
Steroid
Asymmetric joint involvement
Explosive onset
Predominant lower extremity involvement with sparing of wrists and small joints
No periosteal reaction
Late age at onset of arthritis
Abscence of RAF, rheumatoid nodules
Nonspecific histopathologic appearance of synovial lining
