Hypertrophic Pulmonary Osteoarthropathy as an Initial Manifestation of Lung Cancer

Our plain-English summary of Hypertrophic Pulmonary Osteoarthropathy as an Initial Manifestation of Lung Cancer, by S.K. Mohamed Ahmed, Y.K. Mohamedahmed, L. Fadl, et al (Curēus, 2025).

The study

• Authors: S.K. Mohamed Ahmed, Y.K. Mohamedahmed, L. Fadl, D. Salih, R.K. Mohamedahmed
• Journal: Curēus
• Published: 2025;17(12):e98619
• Type of article: Case report
• Cited by: 1 article, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Hypertrophic pulmonary osteoarthropathy (HPOA) is a paraneoplastic syndrome characterised by digital clubbing, periostitis, and arthralgia, most commonly secondary to lung malignancy. This case report presents a man in his 60s with a long history of smoking and asbestos exposure who developed progressive wrist and ankle pain, limb swelling, and enlargement of the hands and feet over eight months. He was initially investigated for rheumatoid arthritis due to positive rheumatoid factor (RF) and anti-citrullinated peptide (anti-CCP) antibodies, but repeated chest X-rays were normal. A CT scan later revealed a left lower lobe lesion, and biopsy confirmed squamous cell carcinoma of the lung. This case underscores the importance of maintaining a high index of suspicion for paraneoplastic syndromes such as HPOA when unexplained arthropathy and digital clubbing occur, even in the absence of respiratory symptoms.

Copyright © 2025, Mohamed Ahmed et al.

In plain English

This case report described one man in his 60s with a 40-year history of smoking and asbestos exposure. It gave no further details of the asbestos exposure. Over eight months he had worsening ankle and wrist pain, joint stiffness, and increasing ring and shoe size. Blood tests were positive for rheumatoid factor and anti-CCP antibodies, and he was investigated for suspected inflammatory arthritis, but anti-inflammatory drugs and a short course of steroids did not help. He later developed a dry cough, weight loss, leg swelling and night sweats, yet his chest X-rays stayed normal. A CT scan showed a 2.8 cm lesion in the left lower lung lobe with lymph node involvement, and a biopsy confirmed squamous cell carcinoma of the lung. The authors concluded that hypertrophic pulmonary osteoarthropathy, a bone and joint condition linked to lung cancer, should be suspected even without breathing symptoms or chest X-ray changes. They also concluded that early CT imaging is essential in such patients, particularly those with significant smoking or asbestos exposure. The report did not assess whether asbestos caused this cancer.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: case report (one patient)
• Who was studied: One man in his 60s, seen at hospitals in the UK (author affiliations include Walsall Manor Hospital), with blood results dated December 2024 and July 2025
• Exposure: Smoking and asbestos exposure, described together as a 40-year history. No fiber type, job, product or dose was given.
• Main results:
  • The patient had an eight-month history of progressive ankle and wrist pain, joint stiffness, and increasing ring and shoe size.
  • His blood tests were abnormal. In December 2024: ESR 93 mm/hr (reference 1-10), anti-CCP 120 U/mL (reference 0-7), CRP 122 mg/L (reference 0.0-5.0) and RF 85 IU/mL (reference under 14). In July 2025: ESR 95 mm/hr, anti-CCP 128 U/mL, CRP 108 mg/L and RF 79 IU/mL.
  • His symptoms persisted and worsened despite non-steroidal anti-inflammatory drugs and a short course of steroids.
  • Six weeks before presentation he developed a new dry cough, a one-stone weight loss over eight weeks, lower-limb swelling and intermittent night sweats.
  • Heart failure was considered less likely because his BNP was 84 pg/mL (reference under 100), and his chest X-ray remained normal.
  • On examination he had pitting edema up to the mid-shin, marked digital clubbing, and tenderness of the wrists and ankles.
  • A CT scan showed a 2.8 cm left lower-lobe lesion abutting the posterior pleura, with mediastinal and hilar lymphadenopathy and omental lymph node involvement.
  • A CT-guided biopsy confirmed squamous cell carcinoma of the lung.
  • In the authors' interpretation, the absence of morning stiffness, the sparing of small hand joints and a non-inflammatory pattern of pain did not fit classic rheumatoid arthritis and suggested a paraneoplastic process.
• The authors' conclusion: The authors concluded that clinicians should maintain a high index of suspicion for hypertrophic pulmonary osteoarthropathy as a sign of lung cancer, even without respiratory symptoms or chest X-ray abnormalities. They also concluded that, in patients with unexplained arthropathy, digital clubbing or atypical serological findings, particularly those with significant smoking or asbestos exposure, early use of CT imaging is essential.

Topics

Medical terms in this study, explained in our Lexicon: Hypertrophic Pulmonary Osteoarthropathy (HPOA), Lung Cancer, Clubbing, Asbestos Exposure, Chest X-Ray, CT Scan, Biopsy, Squamous Cell Carcinoma.

Related studies

• Secondary hypertrophic osteoarthropathy caused by non-pleural or pulmonary tumors — H.J. Meyer, L. Leifels, et al. (2017)
• Hypertrophic osteoarthropathy in childhood malignancy — C.R. Staalman, U. Umans (1993)
• A case of severe arthralgia with malignant mesothelioma-associated hypertrophic osteoarthropathy — H. Yamakawa, A. Sekine, et al. (2016)
• Cardiac tamponade as the initial manifestation of primary pericardial mesothelioma — M. Stein, A. Neuman, et al. (1995)
• Peripheral lymphadenopathy as the initial manifestation of malignant mesothelioma in a child — Y.S. Gong, Y.T. Rong, et al. (2013)
• Sudden death as the initial manifestation of diffuse pleural mesothelioma — J.T. Lie (1989)

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