Images in Clinical Rheumatology
Digital Clubbing: A Patient With Hypertrophic Osteoarthropathy and the Presence of Acro-osteolysis
Hipocratismo digital: paciente con osteoartropatía hipertrófica y presencia de acro-osteólisis
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Aumento de partes blandas a nivel de falanges distales. Marcados cambios destructivos con acro-osteólisis en todas las falanges distales (flechas), con formación de superficies planas en quinta falange bilateral, proliferación ósea a nivel de radio izquierdo y más discreta en base de varias falanges distales (puntas de flecha). B) Radiografía oblicua del pie derecho. Reabsorción de falanges distales de todos los dedos con formación de superficies planas (flechas).</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Ismael Calero-Paniagua, Luís Miguel Prieto-Gañán, Damián Mora-Peña, Francisco Ramón Egea-Aldana" "autores" => array:4 [ 0 => array:2 [ "nombre" => "Ismael" "apellidos" => "Calero-Paniagua" ] 1 => array:2 [ "nombre" => "Luís Miguel" "apellidos" => "Prieto-Gañán" ] 2 => array:2 [ "nombre" => "Damián" "apellidos" => "Mora-Peña" ] 3 => array:2 [ "nombre" => "Francisco Ramón" "apellidos" => "Egea-Aldana" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S2173574319300206" "doi" => "10.1016/j.reumae.2019.02.002" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173574319300206?idApp=UINPBA00004M" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1699258X17303005?idApp=UINPBA00004M" "url" => "/1699258X/0000001500000006/v1_201911200727/S1699258X17303005/v1_201911200727/es/main.assets" ] ] "itemSiguiente" => array:18 [ "pii" => "S2173574319301558" "issn" => "21735743" "doi" => "10.1016/j.reumae.2017.10.009" "estado" => "S300" "fechaPublicacion" => "2019-11-01" "aid" => "1148" "copyright" => "Elsevier España, S.L.U. and Sociedad Española de Reumatología y Colegio Mexicano de Reumatología" "documento" => "article" "crossmark" => 1 "subdocumento" => "sco" "cita" => "Reumatol Clin. 2019;15:e140-e141" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "en" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Images in Clinical Rheumatology</span>" "titulo" => "Mixed crystal arthropathy of the wrist: The contribution of imaging in the diagnostic approach" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "e140" "paginaFinal" => "e141" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Artropatía cristalina mixta de la muñeca: la contribución de la imagen en el enfoque diagnóstico" ] ] "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" => 2747 "Ancho" => 1500 "Tamanyo" => 269950 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Ultrasound images of the right wrist. (A) Longitudinal view of the distal ulna, with grey-scale grade 2 synovitis of the distal radio-ulnar joint (asterisk). (B) Transverse view of the distal radio-ulnar joint, with an intrahyaline hyperechoic band parallel to the surface of the distal ulnar cartilage (arrows). (C) Several hyperechoic spots with a “punctate pattern” of the triangular fibrocartilage complex (arrow heads). L – lunate; R – radium; U – ulna.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Nikita Khmelinskii, Joaquim Polido-Pereira" "autores" => array:2 [ 0 => array:2 [ "nombre" => "Nikita" "apellidos" => "Khmelinskii" ] 1 => array:2 [ "nombre" => "Joaquim" "apellidos" => "Polido-Pereira" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173574319301558?idApp=UINPBA00004M" "url" => "/21735743/0000001500000006/v1_201911250632/S2173574319301558/v1_201911250632/en/main.assets" ] "itemAnterior" => array:19 [ "pii" => "S2173574319300486" "issn" => "21735743" "doi" => "10.1016/j.reumae.2017.12.006" "estado" => "S300" "fechaPublicacion" => "2019-11-01" "aid" => "1172" "copyright" => "Elsevier España, S.L.U. and Sociedad Española de Reumatología y Colegio Mexicano de Reumatología" "documento" => "article" "crossmark" => 1 "subdocumento" => "sco" "cita" => "Reumatol Clin. 2019;15:e136-e137" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "en" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Images in Clinical Rheumatology</span>" "titulo" => "Utility of single-photon emission computed tomography and computed tomography imaging in bone infarction" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "e136" "paginaFinal" => "e137" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Utilidad de las imágenes híbridas SPECT/TC en el infarto óseo" ] ] "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" => 1451 "Ancho" => 2551 "Tamanyo" => 169278 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">2-Stage scintigraphy (A) showing intense increased radiotracer uptake in the proximal thirds of the tibias. The hybrid SPECT/CT images and 3D reconstruction (B) show osteoblastic activity in the epiphysis of both tibias with no involvement of adjacent soft tissues.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Barbara Russo, Juan José Martin-Marcuartu, Alvaro de Bonilla-Damia, Rosario Garcia-Jimenez" "autores" => array:4 [ 0 => array:2 [ "nombre" => "Barbara" "apellidos" => "Russo" ] 1 => array:2 [ "nombre" => "Juan José" "apellidos" => "Martin-Marcuartu" ] 2 => array:2 [ "nombre" => "Alvaro" "apellidos" => "de Bonilla-Damia" ] 3 => array:2 [ "nombre" => "Rosario" "apellidos" => "Garcia-Jimenez" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S1699258X17303121" "doi" => "10.1016/j.reuma.2017.12.007" "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/S1699258X17303121?idApp=UINPBA00004M" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173574319300486?idApp=UINPBA00004M" "url" => "/21735743/0000001500000006/v1_201911250632/S2173574319300486/v1_201911250632/en/main.assets" ] "en" => array:17 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Images in Clinical Rheumatology</span>" "titulo" => "Digital Clubbing: A Patient With Hypertrophic Osteoarthropathy and the Presence of Acro-osteolysis" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "e138" "paginaFinal" => "e139" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Ismael Calero-Paniagua, Luís Miguel Prieto-Gañán, Damián Mora-Peña, Francisco Ramón Egea-Aldana" "autores" => array:4 [ 0 => array:4 [ "nombre" => "Ismael" "apellidos" => "Calero-Paniagua" "email" => array:1 [ 0 => "ismaelcaleropaniagua@yahoo.es" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "Luís Miguel" "apellidos" => "Prieto-Gañán" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 2 => array:3 [ "nombre" => "Damián" "apellidos" => "Mora-Peña" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 3 => array:3 [ "nombre" => "Francisco Ramón" "apellidos" => "Egea-Aldana" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Servicio de Medicina Interna, Hospital Virgen de la Luz, Cuenca, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Unidad de Cuidados Críticos Urgente, San Fernando-Cádiz, San Fernando, Cádiz, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Hipocratismo digital: paciente con osteoartropatía hipertrófica y presencia de acro-osteólisis" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1050 "Ancho" => 2000 "Tamanyo" => 149295 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">(A) Anteroposterior X-ray of both hands. Thickening of the soft tissues at the level of the distal fingers. Marked destructive changes with acro-osteolysis in all of the distal fingers (arrowed), with formation of flat surfaces in both the fifth fingers, bone proliferation at the level of the left radius and more discretely at the base of several distal fingers (arrow points). (B) Oblique X-ray of the right foot. Re-absorption of all of the distal toes with formation of flat surfaces (arrowed).</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">A 75 year-old male with a history of type 2 diabetes, with bilateral infracondylar amputation, chronic obstructive pulmonary disease with respiratory insufficiency and home oxygen therapy. He was admitted due to respiratory infection, and in the physical examination strikingly large bilateral acropachies were found (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). The patient mentioned gradual thickening of the distal fingers during more than 10 years, without ever having felt pain in the said joints. A hand X-ray was requested (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>A). An X-ray of his right foot (in 2008) showed similar findings (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>B), compatible with hypertrophic osteoarthropathy (HOA).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0010" class="elsevierStylePara elsevierViewall">The acropachies and the HOA seem to be different stages of the same process, involving increased angiogenesis with arterial-venous anastomosis, perivascular lymphocytic infiltrate, distal accumulation of collagen fibres and interstitial oedema that cause the bulbous deformation of the fingers. There is also increased osteoclast-osteoblast activity that would explain the bone alterations.</p><p id="par0015" class="elsevierStylePara elsevierViewall">Primary hypertrophic osteoarthropathy is a rare hereditary disease that appears during infancy or adolescence. It predominantly occurs in males, at a ratio of 7:1, and it is more common in Afro-Americans.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">1</span></a> The secondary form may be generalised or localised in 1 or 2 extremities, manifesting by cyanosis of the limbs due to persistent arteriosus ductus, aneurisms, hemiplegia or infectious arthritis.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">2</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">The differential diagnoses to be taken into account in adult patients are: drugs (voriconazole), systemic inflammation (psoriatic arthritis, reactive arthritis), metabolic diseases (thyroid acropathy, vitamin A hypervitaminosis, fluorosis), malignity (multifocal metastatic disease, lymphoma or leukaemia), infection (multifocal osteomyelitis, syphilis), vascular disease (venous insufficiency, systemic vasculitis).<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">1</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">There are 2 radiological of HOA, one with bone neoformation that commences in after puberty in patients with lung disease, and another with acro-osteolysis, which starts in infancy and is associated with congenital cyanotic cardiopathies. The second pattern predominates in the case described, making it an unusual case.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflict of interests</span><p id="par0030" class="elsevierStylePara elsevierViewall">The authors have no conflict of interests to declare.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Conflict of interests" ] 1 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2017-10-11" "fechaAceptado" => "2017-11-23" "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Calero-Paniagua I, Prieto-Gañán LM, Mora-Peña D, Egea-Aldana FR. Hipocratismo digital: paciente con osteoartropatía hipertrófica y presencia de acro-osteólisis. Reumatol Clin. 2019;15:e138–e139.</p>" ] ] "multimedia" => array:2 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 995 "Ancho" => 1500 "Tamanyo" => 152910 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Large bilateral acropachies.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1050 "Ancho" => 2000 "Tamanyo" => 149295 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">(A) Anteroposterior X-ray of both hands. Thickening of the soft tissues at the level of the distal fingers. Marked destructive changes with acro-osteolysis in all of the distal fingers (arrowed), with formation of flat surfaces in both the fifth fingers, bone proliferation at the level of the left radius and more discretely at the base of several distal fingers (arrow points). (B) Oblique X-ray of the right foot. Re-absorption of all of the distal toes with formation of flat surfaces (arrowed).</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:2 [ 0 => array:3 [ "identificador" => "bib0015" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Hypertrophic osteoarthropathy: clinical and imaging features" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "F.Y. Yap" 1 => "M.R. Skalski" 2 => "D.B. Patel" 3 => "A.J. Schein" 4 => "E.A. White" 5 => "A. Tomasian" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Radiographics" "fecha" => "2017" "volumen" => "37" "paginaInicial" => "153" "paginaFinal" => "171" ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0020" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Unilateral hypertrophic osteoarthropathy in a patient with a vascular graft infection" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "G. Ahrenstorf" 1 => "M. Rihl" 2 => "M.A. Pichlmaier" 3 => "H. Rosenthal" 4 => "T. Witte" 5 => "R.E. Schmidt" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "J Clin Rheumatol" "fecha" => "2012" "volumen" => "18" "paginaInicial" => "307" "paginaFinal" => "309" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23120763" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/21735743/0000001500000006/v1_201911250632/S2173574319300206/v1_201911250632/en/main.assets" "Apartado" => array:4 [ "identificador" => "5795" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Images in Clinical Rheumatology" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/21735743/0000001500000006/v1_201911250632/S2173574319300206/v1_201911250632/en/main.pdf?idApp=UINPBA00004M&text.app=https://reumatologiaclinica.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173574319300206?idApp=UINPBA00004M" ]
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