A case of primary hypertrophic osteoarthropathy: Management considerations

Dear Editor, A 35-year-old man was referred with a history dating back to childhood, where he was noted to have swelling of his hands and feet from an early age. By the age of 14, he started to develop pain in his knees, ankles and particularly the right foot. This pain worsened over subsequent years and led to a debulking operation on the right foot. Unfortunately the operation was of no benefit, with ongoing right foot pain rated as 10/10 in severity, and limiting his ability to stand and walk for any significant period of time. He reported associated hyperhidrosis of the hands and feet, and widespread eczema as a child. Interestingly there was no documented family history of the condition, but on further questioning, his parents were noted to be second cousins. Figure 1 represents a photograph of his hands, while Figure 2 shows a plain radiograph of his hands.