Table 1 Distinguishing clinical features and radiographic appearance of conditions that may present with acro-osteolysis in children
From: Lost bones: differential diagnosis of acro-osteolysis seen by the pediatric rheumatologist
| Differential diagnosis of acro-osteolysis | Distinguishing Clinical Features | Radiographic Appearance |
|---|---|---|
| Genetic Disorders | Terminal tuft resorption | |
| Primary hypertrophic osteoarthropathy (PHO) |
Clubbing, hyperhidrosis *Consider secondary HO | Tuft resorption involving toes then fingers, periostitis |
| Hajdu-Cheney Syndrome | Short stature, craniofacial abnormalities, severe osteoporosis, bone deformities | Progressive diffuse bone resorption |
| Skeletal dysplasias and related disorders | Bone abnormalities | Cortical bone irregularities, osteopenia |
| Laminopathies | Involvement of skin, fat, muscle | |
| Rheumatic Diseases | ||
| Psoriatic arthritis (PsA) | Psoriatic skin and/or nail changes, arthritis (predilection for distal interphalangeal joint involvement) | Destruction of interphalangeal joint (joint space narrowing, erosions), terminal tuft resorption, periostitis, spur formation, ankylosis |
| Systemic sclerosis (SSc) | Raynaud phenomenon, skin thickening, flexion contractures | Terminal tuft resorption, joint space narrowing, erosion, osteopenia, flexion contractures, calcinosis |
| Others | Systemic symptoms | |
| Hyperparathyroidism | 1Underlying conditions leading to secondary hyperparathyroidism (e.g. Vitamin D deficiency, renal disease) | Terminal tuft resorption, diffuse osteolysis, brown tumors (lytic lesions) |
| Symptoms of hypercalcemia in primary hyperparathyroidism | ||
| Neuropathy | Underlying conditions (e.g. diabetes mellitus, carpal tunnel syndrome), hereditary forms | Terminal tuft resorption |
| Miscellaneous | Unilateral involvement | Terminal tuft resorption |
| Local factors: Repetitive trauma, thermal injury | Exposure on clinical history | |
| Occult spinal dysraphism | Lower extremity involvement | |