Rheumatologic manifestations of pachydermoperiostosis and preliminary experience with bisphosphonates

Objective. Pachydermoperiostosis is manifested by finger clubbing, hypertro phic skin changes, and periosteal bone formation. We describe 5 cases revea led primarily by their rheumatologic manifestations. Also reported are prel iminary experiences on the use of intravenous pamidronate as a treatment. Methods. This is a retrospective study including the analysis of clinical m anifestations, laboratory results and morphological examinations gathered f rom patients' medical records. We evaluated efficacy of treatment with 1 mg /kg iv pamidronate in the 3 new cases. Results. Before treatment with iv pamidronate, the patients' global assessm ent was poor (twice) and very poor (once). The physician's global assessmen t was poor in 3 patients. After treatment with iv pamidronate, 2 patients h ad significant improvement. Physician and patient global assessments were v ery good, good, and moderate. No side effects were observed. All biological variables were within normal ranges at 12 month followup visit. Conclusion. Pachydermoperiostosis must be recognized by the rheumatologist, since it can present symptomatically through articular manifestations. Whe n conventional treatment modalities fail, iv pamidronate might be useful.