Hypertrophic pulmonary osteoarthropathy

Episodic or chronic arthritis and hypertrophic pulmonary osteoarthropathy may also occur due to immune complex formation in response to chronic inflammation.11 Digital clubbing is commonly observed and is a marker for hypoxia. 

Short courses of non-steroidal anti-inflammatory drugs (NSAIDs) can be used to treat CF-related arthritis and hypertrophic pulmonary osteoarthropathy.5 The impact on neutrophil recruitment in the lung with long-term NSAID therapy at lower analgesic doses is unknown. 

Hypertrophic osteoarthropathy (hour-glass nails, clubbed fingers) (s. fig. 4.18), which has been known since 1884, is not caused by hypoxia, as has been assumed up to now. (18) The cause is to be found in the intrapulmonary arteriovenous shunts from the venous limb of the pulmonary vessels, megakaryocytes and thrombocyte aggregates pass directly through the shunts into the arterial limb and hence (unfiltered, uncatabolized or not... 

Arthritis may occur in CF and can take one of several forms. The arthritis may be either mono- or polyarticular and usually is nondestructive. An episodic form is most common and may be due to immune complexes formed in response to the chronic pulmonary infections. Hypertrophic osteoarthropathy occurs in CF, as it does in association with other pulmonary diseases. The incidence of arthritis may be increasing as median survival age increases. Osteopenia and osteoporosis also occur more frequently in adults with CF. The causes of the resulting bone deminerahzation are multifactorial and include vitamin D malabsorption, decreased vitamin D conversion (via sunlight), delayed puberty and endocrine development, poor nutrition, limited physical activity, and chronic acidosis. 

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