Prospective study of periostitis and finger clubbing in primary biliary cirrhosis and other form of chronic liver disease

Gut (Impact Factor: 14.66). 04/1981; 22(3):203-6. DOI: 10.1136/gut.22.3.203
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The association of finger clubbing and periostitis has been reported in primary biliary cirrhosis and, more rarely, in other forms of chronic liver disease. The prevalence of periostitis and its relationship to finger clubbing is unknown. In this prospective study, we have determined the prevalence of periostitis and finger clubbing in 74 patients with primary biliary cirrhosis and 54 with other forms of chronic liver disease. Clubbing was present in 24% of patients with primary biliary cirrhosis, 29% with HBsAg negative chronic active hepatitis, and 23% in the group of miscellaneous liver diseases. Symmetrical periostitis affecting the tibiae and fibulae occurred in 35% of patients with primary biliary cirrhosis, 29% with chronic, active hepatitis and 40% of patients in the miscellaneous group. The distal radii and ulnae were affected in only eight patients (6%). In primary biliary cirrhosis, the presence of finger clubbing was strongly associated with periostitis (P less than 0.01), but this association was uncommon in other forms of chronic liver disease. In all forms of chronic liver disease periostitis commonly occurs in the absence of finger clubbing. Marked tenderness over the distal leg bones is a reliable sign of underlying periostitis, but this sign is present in only a third of affected patients. This study indicates that periostitis affecting the lower leg bones is common in patients with chronic liver disease, and its presence should be sought whether or not the patient has finger clubbing.

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Available from: Owen Epstein, Mar 22, 2014
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    • "Case report of two children with cyanotic heart disease presenting with clubbing and HOA Gastrointestinal IBD Kitis et al 1979 26 75 of 200 Patients with Crohn's disease and 15 of 103 patients with ulcerative colitis had clubbing (hyponychial angle) Liver disease Epstein et al 1981 27 24% Of patients with primary biliary cirrhosis, 29% of patients with chronic active hepatitis, and 24% of patients with mixed liver disease had clubbing (profile angle) Celiac sprue Mohindra et al 2001 28 Of 42 Indian children with celiac disease, 6 had clubbing Juvenile polyposis coli Grosfeld and West 1986 29 Of 5 children with aggressive polyposis, two also had clubbing Infectious TB Kaplan and Munson 1941 30 Of 426 patients with TB, 72 had clubbing Infective endocarditis Lowes et al 1980 31 Clubbing was ''nearly as common'' as heart failure which was found in ''nearly half of the [60] patients'' with infective endocarditis Chronic parasite infection Bowie et al 1978 32 All 10 African children infected with Trichuris trichiura (whipworm) had marked clubbing Ayad El-Masry et al 1986 33 Of 108 Egyptian farmers with schistosomal colonic polyposis, 61 had clubbing HIV Rubinstein et al 1986 34 All 11 children with pulmonary lymphoid hyperplasia secondary to AIDS had clubbing Cribier et al 1998 35 Of 155 HIV-positive patients, 9 had clubbing vs none of the HIV-negative control subjects Endocrine Thyroid disease Fatourechi et al 2002 36 Of 178 patients with thyroid dermopathy, 35 had clubbing Vascular Venous stasis Sarteel et al 1985 37 Unreferenced literature review suggests that clubbing is associated with venous stasis but does not provide clinical evidence Psychiatric Laxative abuse Pines et al 1983 38 Case report of two patients who abused laxatives with finger clubbing and a review of 4 previously published cases "
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