Primary idiopathic osteoarthropathy
Dhia Kaffel, Hend Riahi
The Pan African Medical Journal. 2017;28:88. doi:10.11604/pamj.2017.28.88.13295

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Primary idiopathic osteoarthropathy

Cite this: The Pan African Medical Journal. 29/09/2017 ;28:88. doi:10.11604/pamj.29/09/2017 .28.88.13295

Received: 09/07/2017 - Accepted: 17/09/2017 - Published: 29/09/2017

Key words: Primary idiopathic osteoarthropathy, digital clubbing, hippocratic fingers, periostosis

© Dhia Kaffel et al. The Pan African Medical Journal - ISSN 1937-8688. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Corresponding author: Dhia Kaffel, Rheumatology Department, Kassab Institute, Manouba, Tunisia (

Primary idiopathic osteoarthropathy

Dhia Kaffel1,&, Hend Riahi2


1Rheumatology Department, Kassab Institute, Manouba, Tunisia, 2Radiology Department, Kassab Institute, Manouba, Tunisia



&Corresponding author
Dhia Kaffel, Rheumatology Department, Kassab Institute, Manouba, Tunisia



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A 49-year-old man presented with arthralgias and effusion of the knees. His past medical syndrome revealed digital clubbing for 17 years (A) and an idiopathic Raynaud syndrome. Radiographs of the tibias and fibulas showed bilateral, symmetric, extended and multilayered periosteal thickening (B). Thoracic CT and cardiac ultrasound were normal, as well as inflammatory, hepatic and renal tests. Infectious investigations were negative. The diagnosis of primary idiopathic osteoarthropathy (HOA) was made with 3-year follow-up. HOA is a syndrome characterized by three clinical features: digital clubbing (also termed Hippocratic fingers), periostosis of tubular bones, and synovial effusions. HOA can be a primary entity, or can be secondary to extra skeletal conditions. Primary HOA is a rare disease, with male predilection. Hippocratic fingers show a distinctive bulbous deformity of the fingertips. It can be associated with large joint’s effusions but there is neither synovial membrane hypertrophy nor inflammatory cell exudation. Radiographs may show an acro-osteolysis, periostosis of tubular bones. The tibia, fibula, radius, and ulna are the most commonly affected bones.


Figure 1: A) digital clubbing (hippocratic fingers); B) radiographs of the tibias and fibulas show bilateral extended and multilayered periosteal thickening

















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