Acro-osteolysis

Notes

## Basic introduction

  • Acro-osteolysis is a resorption of the distal bony phalanges[a]
  • It has two patterns of resorption in adults:
  • Diffuse
  • Bandlike

## Statistics

  • It occurs in about 20 - 25% cases of systemic sclerosis[b]

## Pathophysiology

  • It is thought to results from:
  • Impairment of blood supply
  • Pressure from skin tightening

## Causes of Acro-osteolysis

  • Psoriasis/pyknodysostosis
  • Injury such as thermal burn and frost bite
  • Neuropathy such as diabetes and leprosy
  • Collagen vascular disease such as scleroderma
  • Raynaud disease
  • Hyperparathyroidism
  • Familial such as Hajdu-Cheney syndrome (Acro-osteolysis dominant type, AOD)
  • Others such as polyvinyl chloride (PVC) exposure and progeria

(These are best remembered by using the mnemonic “PINCH FO”)

Symptoms
  • Resorption at the terminal tuft
  • Cold hands and feet
  • Difficulty with hand grip
  • Fatigue
  • Myalgias
  • Paresthesias
  • Reduced libido
  • Fingertips appearing bulbous
  • Shortening of the distal phalanges
  • Pseudo clubbing
  • Peg-shaped phalanges
Diagnosis
  • Clinical review
Differential
  • Frostbite
  • Hyperparathyroidism
  • Neurologic disorders
  • Psoriasis
  • Renal osteodystrophy
  • Scleroderma
Prevention
  • None is known
Reference

a. Kemp, S. S., Dalinka, M. K., & Schumacher, H. R. (1986). Acro-osteolysis: etiologic and radiological considerations. Jama, 255(15), 2058-2061.

b. Avouac, J., Guerini, H., Wipff, J., Assous, N., Chevrot, A., Kahan, A., & Allanore, Y. (2006). Radiological hand involvement in systemic sclerosis. Annals of the rheumatic diseases, 65(8), 1088-1092.

c. Benitha, R., Modi, M., & Tikly, M. (2002). Osteolysis of the cervical spine and mandible in systemic sclerosis: a case report with computed tomography and magnetic resonance imaging findings. Rheumatology, 41(10), 1198-1200.

Management
  • Rehabilitation program
  • Management of underlying condition(s)
  • Splits
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