Images in Clinical Rheumatology
Reactive Periostitis of the Hand
Periostitis reactiva de la mano
María Ángeles Blázquez Cañamero
, Walter Alberto Sifuentes Giraldo, Javier Bachiller Corral
Corresponding author
Servicio de Reumatología, Hospital Universitario Ramón y Cajal, Madrid, Spain
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"documento" => "article" "crossmark" => 0 "subdocumento" => "sco" "cita" => "Reumatol Clin. 2014;10:260-1" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 2299 "formatos" => array:3 [ "EPUB" => 61 "HTML" => 1827 "PDF" => 411 ] ] "en" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Images in Clinical Rheumatology</span>" "titulo" => "Arthritis and Onychophagia: A Confounding Factor" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "260" "paginaFinal" => "261" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Artritis y onicofagia: un factor de confusión" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1200 "Ancho" => 871 "Tamanyo" => 259947 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Nail disorders by onychophagia: absence of the distal end of the nail, subungual ecchymosis, callus type mechanical injury, deformity of the paronychium and characteristic grooves in the nail, indicative of chronic trauma of the nail bed.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Lucía Pantoja Zarza, Carolina Díez Morrondo, José Antonio Manjón Haces" "autores" => array:3 [ 0 => array:2 [ "nombre" => "Lucía" "apellidos" => "Pantoja Zarza" ] 1 => array:2 [ "nombre" => "Carolina" "apellidos" => "Díez Morrondo" ] 2 => array:2 [ "nombre" => "José Antonio" "apellidos" => "Manjón Haces" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S1699258X13001769" "doi" => "10.1016/j.reuma.2013.05.010" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1699258X13001769?idApp=UINPBA00004M" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173574313001354?idApp=UINPBA00004M" "url" => "/21735743/0000001000000004/v1_201406280041/S2173574313001354/v1_201406280041/en/main.assets" ] "en" => array:17 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Images in Clinical Rheumatology</span>" "titulo" => "Reactive Periostitis of the Hand" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "262" "paginaFinal" => "263" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "María Ángeles Blázquez Cañamero, Walter Alberto Sifuentes Giraldo, Javier Bachiller Corral" "autores" => array:3 [ 0 => array:4 [ "nombre" => "María Ángeles" "apellidos" => "Blázquez Cañamero" "email" => array:1 [ 0 => "mariblazquez@gmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">¿</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "Walter Alberto" "apellidos" => "Sifuentes Giraldo" ] 2 => array:2 [ "nombre" => "Javier" "apellidos" => "Bachiller Corral" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Servicio de Reumatología, Hospital Universitario Ramón y Cajal, Madrid, Spain" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Periostitis reactiva de la mano" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Fig. 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 740 "Ancho" => 975 "Tamanyo" => 308440 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Photomicrograph of the lesion in which the production of immature osteoid (asterisk) is observed, with abundant osteoblasts (arrows) originating from a fibrous stroma (arrowheads) (hematoxylin–eosin, 10×).</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">The patient is a 29-year-old woman, who complains of swelling and pain in the fifth finger of the left hand lasting for 3 months. She had no medical history and no previous trauma of the referred finger. On examination, she presented a tumor of 1.5<span class="elsevierStyleHsp" style=""></span>cm<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>0.5<span class="elsevierStyleHsp" style=""></span>cm on the tip of the finger and the subungual region, of indurated consistency which adhered to deep planes, with mild erythema and tenderness. Radiological studies showed a well-circumscribed, nodular ossified lesion with irregular borders, adhered to the l periosteum of the distal phalanx, without erosion of the cortex (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). Laboratory studies, including biochemistry, hematology and acute phase reactants were all normal. Excision of the lesion was performed and the histopathological study revealed fibrous tissue and fibroblasts with prominent nuclei without atypia in its periphery, and immature osteoid deposits surrounded by an osteoblastic rim in the central area (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>). These findings were consistent with the diagnosis of florid reactive periostitis of the hand (FRPH). There was no recurrence of the lesion.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0010" class="elsevierStylePara elsevierViewall">FRPH is a rare benign entity characterized by a lush production of osteoblastic proliferative fibrous stroma in the periosteum of the fingers.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> Its pathogenesis is unknown but is considered to correspond more to a reactive process than to a neoplasm, with a history of trauma being present in up to 50% of cases.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> Although it was described in 1933<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> there still is confusion in the literature caused by different denominations, including <span class="elsevierStyleItalic">paraostal fasciitis</span>, <span class="elsevierStyleItalic">ossifying fasciitis</span>, <span class="elsevierStyleItalic">fibro-osseous pseudotumor</span>, <span class="elsevierStyleItalic">pseudomalignant bone tumor of the soft tissue of the fingers</span> and <span class="elsevierStyleItalic">nodular fasciitis</span>, with FRPH being the accepted term.<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2,4</span></a> It is most frequently located in the proximal phalanx, followed by the middle phalanx, metacarpal joints and distal phalanx; it is rare in the first two fingers. It usually occurs in women during the second and third decades of life, and is clinically characterized by swelling, pain and erythema of the affected finger.<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2,5</span></a> Radiographs show increased soft tissue and periosteal new bone formation, which may have a lamellar or mature bone<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> appearance. The cortex is usually intact, although erosions have been occasionally described.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> The differential diagnosis includes infections (septic tenosynovitis, soft tissue abscess with bone involvement, cortical osteomyelitis), myositis ossificans, benign tumors such as giant cell tendon sheath tumors and osteochondroma, and malignant ones such as the paraostal and periosteal osteosarcoma, synovial sarcoma and periosteal chondrosarcoma.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,5</span></a> The recommended treatment is local excision, which is curative in most cases.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> In conclusion, although FRPH is an uncommon lesion, it should be taken into account because it can simulate other more serious conditions such as malignant bone neoplasms.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Ethical Responsibilities</span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Protection of people and animals</span><p id="par0015" class="elsevierStylePara elsevierViewall">The authors declare that no experiments have been performed on humans or animals.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Data confidentiality</span><p id="par0020" class="elsevierStylePara elsevierViewall">The authors declare that they have followed the protocols of their workplace regarding the publication of data from patients and that all patients included in the study have received sufficient information and have given their written informed consent to participate in the study.</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Right to privacy and informed consent</span><p id="par0025" class="elsevierStylePara elsevierViewall">The authors have obtained informed patients and/or subjects referred to in the article. This document is in the possession of the corresponding author.</p></span></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conflict of Interest</span><p id="par0030" class="elsevierStylePara elsevierViewall">The authors declare no conflicts of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:3 [ 0 => array:3 [ "identificador" => "sec0005" "titulo" => "Ethical Responsibilities" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0010" "titulo" => "Protection of people and animals" ] 1 => array:2 [ "identificador" => "sec0015" "titulo" => "Data confidentiality" ] 2 => array:2 [ "identificador" => "sec0020" "titulo" => "Right to privacy and informed consent" ] ] ] 1 => array:2 [ "identificador" => "sec0025" "titulo" => "Conflict of Interest" ] 2 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2013-04-08" "fechaAceptado" => "2013-05-29" "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Blázquez Cañamero MÁ, et al. Periostitis reactiva florida de la mano. Reumatol Clin. 2014;10:262–263.</p>" ] ] "multimedia" => array:2 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 824 "Ancho" => 825 "Tamanyo" => 91011 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Anteroposterior (A) and lateral (B) X-rays of the fifth finger of the left hand showing an ossified nodular lesion attached to the periosteum of the distal phalanx without cortical erosion.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Fig. 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 740 "Ancho" => 975 "Tamanyo" => 308440 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Photomicrograph of the lesion in which the production of immature osteoid (asterisk) is observed, with abundant osteoblasts (arrows) originating from a fibrous stroma (arrowheads) (hematoxylin–eosin, 10×).</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:6 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Periostitis reactiva florida: caso clínico y actualización del tema" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "J. 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Español" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Chir Main" "fecha" => "2003" "volumen" => "22" "paginaInicial" => "99" "paginaFinal" => "103" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12822245" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0025" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Florid reactive periostitis of the hand" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "R. Vinglas" 1 => "S.B. Schnall" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Am J Orthop (Belle Mead NJ)" "fecha" => "2010" "volumen" => "39" "paginaInicial" => "396" "paginaFinal" => "398" ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0030" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Florid reactive periostitis of the hands" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "N.A. Jambhekar" 1 => "S.S. Desai" 2 => "A. Puri" 3 => "M. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 12 | 1 | 13 |
| 2024 October | 89 | 33 | 122 |
| 2024 September | 104 | 17 | 121 |
| 2024 August | 119 | 35 | 154 |
| 2024 July | 119 | 34 | 153 |
| 2024 June | 93 | 24 | 117 |
| 2024 May | 127 | 41 | 168 |
| 2024 April | 108 | 14 | 122 |
| 2024 March | 104 | 34 | 138 |
| 2024 February | 83 | 29 | 112 |
| 2024 January | 109 | 24 | 133 |
| 2023 December | 110 | 21 | 131 |
| 2023 November | 113 | 20 | 133 |
| 2023 October | 111 | 27 | 138 |
| 2023 September | 123 | 37 | 160 |
| 2023 August | 120 | 16 | 136 |
| 2023 July | 99 | 29 | 128 |
| 2023 June | 103 | 24 | 127 |
| 2023 May | 152 | 31 | 183 |
| 2023 April | 114 | 13 | 127 |
| 2023 March | 146 | 28 | 174 |
| 2023 February | 98 | 28 | 126 |
| 2023 January | 108 | 19 | 127 |
| 2022 December | 127 | 31 | 158 |
| 2022 November | 160 | 21 | 181 |
| 2022 October | 141 | 31 | 172 |
| 2022 September | 132 | 37 | 169 |
| 2022 August | 189 | 37 | 226 |
| 2022 July | 134 | 36 | 170 |
| 2022 June | 101 | 35 | 136 |
| 2022 May | 124 | 43 | 167 |
| 2022 April | 97 | 39 | 136 |
| 2022 March | 88 | 45 | 133 |
| 2022 February | 91 | 20 | 111 |
| 2022 January | 122 | 45 | 167 |
| 2021 December | 84 | 41 | 125 |
| 2021 November | 80 | 49 | 129 |
| 2021 October | 87 | 47 | 134 |
| 2021 September | 75 | 32 | 107 |
| 2021 August | 73 | 34 | 107 |
| 2021 July | 64 | 27 | 91 |
| 2021 June | 88 | 43 | 131 |
| 2021 May | 94 | 36 | 130 |
| 2021 April | 331 | 89 | 420 |
| 2021 March | 166 | 27 | 193 |
| 2021 February | 105 | 27 | 132 |
| 2021 January | 83 | 21 | 104 |
| 2020 December | 60 | 32 | 92 |
| 2020 November | 65 | 19 | 84 |
| 2020 October | 55 | 8 | 63 |
| 2020 September | 48 | 32 | 80 |
| 2020 August | 32 | 21 | 53 |
| 2020 July | 43 | 11 | 54 |
| 2020 June | 48 | 24 | 72 |
| 2020 May | 37 | 15 | 52 |
| 2020 April | 31 | 16 | 47 |
| 2020 March | 15 | 4 | 19 |
| 2020 February | 2 | 0 | 2 |
| 2018 December | 2 | 0 | 2 |
| 2018 May | 8 | 0 | 8 |
| 2018 April | 86 | 8 | 94 |
| 2018 March | 92 | 11 | 103 |
| 2018 February | 51 | 5 | 56 |
| 2018 January | 86 | 3 | 89 |
| 2017 December | 61 | 4 | 65 |
| 2017 November | 70 | 4 | 74 |
| 2017 October | 47 | 9 | 56 |
| 2017 September | 49 | 4 | 53 |
| 2017 August | 95 | 15 | 110 |
| 2017 July | 85 | 5 | 90 |
| 2017 June | 79 | 7 | 86 |
| 2017 May | 79 | 11 | 90 |
| 2017 April | 59 | 9 | 68 |
| 2017 March | 55 | 5 | 60 |
| 2017 February | 52 | 9 | 61 |
| 2017 January | 41 | 2 | 43 |
| 2016 December | 88 | 15 | 103 |
| 2016 November | 75 | 2 | 77 |
| 2016 October | 129 | 10 | 139 |
| 2016 September | 185 | 4 | 189 |
| 2016 August | 113 | 3 | 116 |
| 2016 July | 65 | 6 | 71 |
| 2016 April | 2 | 0 | 2 |
| 2015 December | 2 | 0 | 2 |
| 2015 August | 1 | 0 | 1 |
| 2015 July | 23 | 6 | 29 |
| 2015 June | 53 | 5 | 58 |
| 2015 May | 55 | 10 | 65 |
| 2015 April | 48 | 7 | 55 |
| 2015 March | 34 | 6 | 40 |
| 2015 February | 42 | 5 | 47 |
| 2015 January | 65 | 11 | 76 |
| 2014 December | 63 | 8 | 71 |
| 2014 November | 40 | 10 | 50 |
| 2014 October | 44 | 8 | 52 |
| 2014 September | 50 | 8 | 58 |
| 2014 August | 54 | 15 | 69 |
| 2014 July | 62 | 24 | 86 |
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