Hypertrophic osteoarthropathy in an adult macaque.

OBJECTIVE: To evaluate through differential diagnosis whether hypertrophic osteoarthropathy was present on an adult macaque skeleton. MATERIALS: Skeletal remains of a well-preserved adult macaque (Macaca) of unknown species curated by the archaeology department at University College London. METHODS: Macroscopic and radiographic evaluation of pathological lesions. RESULTS: Widespread bilateral and symmetrical periosteal new bone growth primarily affecting the limbs was observed. CONCLUSION: A careful differential diagnosis of the lesions and comparison with previously published cases of hypertrophic osteoarthropathy among humans and non-humans suggests this animal displays a case of Hypertrophic osteoarthropathy. SIGNIFICANCE: Only been three reported cases of HOA in non-human primates have been reported, and all were apes. This study serves as the first reported case of HOA among non-hominoid simians, providing a detailed description of the skeletal lesions to aid future with paleopathological analyses. LIMITATIONS: Small sample sizes for comparison and lack of context for this specimen limits discussion of the scope of this disease among non-human primates. SUGGESTIONS FOR FURTHER RESEARCH: Re-evaluate skeletal collections which have not been subject to recent osteological and pathological analysis.

Co-morbidity with hypertrophic osteoarthropathy: A possible Iron Age Sarmatian case from the Volga steppe of Russia.

PURPOSE: Hypertrophic osteoarthropathy (HOA) is a condition that can be inherited or acquired. It causes diffuse periosteal new bone formation on the long bones, with a predilection for the appendicular skeleton. When acquired, it is a nonspecific indicator of systemic disease that arises following a primary condition. This paper reviews the palaeopathological literature associated with this rare condition. It also describes the first possible case of co-morbidity associated with hypertrophic osteoarthropathy in an adult skeleton (cal. BC 170 - 1 cal. AD) from the mobile pastoralist Sarmatian culture of the Volga steppes of Russia. METHODS: Macroscopic and radiological examination provide differential diagnoses of the lesions, while clinical and bioarchaeological analyses offer insights into the possible experience of disease and social implications of care among the nomadic populations of Iron Age Russia. RESULTS: The analysis of Sk. 6524.102 displays lesions that may be due to both hypertrophic osteoarthropathy and osteomalacia. The man was physically impaired and his participation in physically challenging activities would have been limited. CONCLUSIONS: The study stresses that co-morbidity is a key parameter when interpreting disease in past populations, particularly when the diagnosis involves hypertrophic osteoarthropathy. SIGNIFICANCE: This is the first case of hypertrophic osteoarthropathy identified in Eurasian prehistoric populations. The research emphasises the significance of co-morbidity in the past. LIMITATIONS: The diagnosis of co-morbid diseases in human remains is extremely complex and the conditions were identified as most probable by a process of elimination. SUGGESTIONS FOR FURTHER RESEARCH: Further studies should be dedicated to understanding co-morbidity in the past.

Diagnostic value of micro-CT in comparison with histology in the qualitative assessment of historical human postcranial bone pathologies.

Micro-computed tomography (muCT) is of great interest for palaeopathological examination because it is less invasive than histology. This study evaluates the diagnostic value of muCT for postcranial macerated bones. We investigated five specimens (osteomyelitis, tuberculosis, trauma, osteosarcoma and hypertrophic osteoarthropathy) of a pathology reference series by muCT and polarised light microscopy. The 3D muCT images allow an easy orientation within the specimen. Surface structures, thickness, continuity of the cortex and number, thickness and orientation of the trabeculae can be evaluated. The high number of muCT slices helps to choose the most interesting areas for further investigations. Grey value images display the degree of mineralisation. Yet, the differentiation between woven and lamellar bone is only possible using polarised light microscopy. muCT is a tool of high value for the examination of postcranial bone disorders. It cannot replace histological examinations completely because it cannot assess the bone quality (woven or lamellar). For the choice of the optimal location where slices for the microscopic investigation are later cut in heterogeneous samples, muCT is very useful. Therefore, we suggest performing the muCT examination first, followed by histology if necessary.

Osteoartropatia hipertrófica primária: descriçäo de um caso e revisäo da literatura / Osteoarthropathy primary hypertrophic: report of a case and review of the literature

Na atividade ambulatorial da Disciplina de Ortopedia da Faculdade de Medicina deparamos com um caso de osteoartropatia hipertrófica primária. O paciente (36 anos, sexo masculino) queixava-se de dor e inchaço de joelhos, tornozelos e punhos. Na anamnese foram observados antecedentes familiares, início na puberdade e ausência de queixas nos diversos aparelhos. Ao exame físico ortopédico havia fácies leonino, espessamento de punho e tornozelo, baqueteamento digital, unhas em "vidro de relógio" e hiperidrose palmoplantar. Foram realizados exames radiológicos, com a detecçao de periostite e espessamento pericortical. Diagnosticou-se osteoartropatia hipertrófica primária, sendo realizado tratamento sintomático. Diante disso, fizemos um levantamento da literatura de 1989 a 1992, onde obtivemos noçoes de definiçao, história da doença, clínica, genética, patogenia, histologia, diagnóstico, dignóstico diferencial e tratamento. A osteoartropatia hipertrófica primária é uma síndrome rara, de etiologia desconhecida, com história curiosa, de herança basicamente dominante e com patogenia nao bem definida. É caracterizada por baqueteamento dos dedos, paquidermia, periostite, astralgia, "unhas em vidro de relógio", verticis gyrata. Nao está associada a nenhum outro distúrbio. Inicia-se na puberdade e apresenta comprometimento familiar. Seu diagnóstico é basicamente clínico e radiológico, devendo ser diferenciada da forma secundária, acromegalia, leprose e outros. O tratamento consiste em antiflamatórios e analgésicos. A associaçao clínica-literatura mostrou que sao necessários mais pesquisa e estudos sobre esta patologia rara e pouco conhecida.

Evidence of hypertrophic osteoarthropathy in human skeletal remains from pre-Hispanic Mesoamerica.

Hypertrophic osteoarthropathy is one of the earliest recognized disease entities in the history of medicine. It has a peculiar periosteal proliferation distinctive from other bone diseases. In its advanced stage, it leaves an indelible mark on the skeleton. It has been recently shown that digital clubbing is accompanied by a bone remodeling process of the underlying phalanges. Thus, theoretically, this entity can be recognized in ancient human skeletal remains. We studied part of the collection of skeletal remains from pre-Hispanic Mesoamerica preserved at the National Museum of Anthropology of Mexico City. We examined 1000 specimens and found 2 skeletons with widespread, bilateral, symmetric periosteal proliferation of the tubular bones in addition to the bone remodeling changes of the distal phalanges. One of the specimens was from the Formative period (2000 B.C. to 100 A.D.). We conclude that hypertrophic osteoarthropathy can be recognized in ancient human skeletal remains and that this disease was present in Mesoamerica near the time of the original description of clubbing by Hippocrates about 2500 years ago.

History of hypertrophic osteoarthropathy (HOA).

Hypertrophic osteoarthropathy (HOA) was first described in 1868 as "hyperostosis of the entire skeleton". It has also been mistaken for acromegaly. In 1887-1888 the first description was given of a dermatological disorder "cutis verticis girata" which coexisted with the peculiar bone anomalies of HOA. In 1890 HOA was named "osteoarthropatie hypertrophiante pneumique". Later a distinction was made between the rare idiopathic (or primary) form, also called "pachydermoperiostosis" and the more common secondary form due to concomitant disorders involving the lungs and pleura. The primary form usually develops shortly after puberty or during adolescence and has not been found associated with underlying disease. Secondary HOA was initially called "hypertrophic pulmonary osteoarthropathy" because it is frequently associated with various malignancies or chronic infections of the lung and pleura. Later, since the site of primary disease may be elsewhere, involving the gut and the cardiovascular, hepatobiliary and endocrine systems, this designation fell into disuse. In some cases of secondary HOA, the osteoarthropatic and facial skin changes subside after pneumonectomy or other procedures. A disease resembling human HOA has been also described in dogs.