Hypertrophic osteoarthropathy (HOA) results in clubbing of the fingers or toes. There are two types: primary (PHO) and secondary (SHO). Genetics cause PHO, and underlying conditions cause SHO. Providers diagnose HOA with a physical exam and specific tests. Treatment involves managing symptoms for PHO and treating the underlying condition for SHO.
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Hypertrophic osteoarthropathy (HOA) is a condition that causes clubbing of the fingers or toes. People with HOA will have:
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Cleveland Clinic is a non-profit academic medical center. Advertising on our site helps support our mission. We do not endorse non-Cleveland Clinic products or services. Policy
Underlying health problems may cause hypertrophic osteoarthropathy. But sometimes, people with HOA don’t have any other health conditions.
Hypertrophic osteoarthropathy may appear during childhood, in adolescence or not til later in life. HOA itself isn’t harmful, but any underlying conditions may need treatment.
There are two types of hypertrophic osteoarthropathy:
People of every gender and race can have hypertrophic osteoarthropathy.
Primary hypertrophic osteoarthropathy usually appears during the first year after birth or during puberty. PHO is more common in:
Secondary hypertrophic osteoarthropathy usually appears between ages 55 and 75.
Researchers don’t know exactly how many people have hypertrophic osteoarthropathy. But 95% to 97% of people with HOA have the secondary type.
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Genetic changes (mutations) present at birth cause primary hypertrophic osteoarthropathy. Either one or both parents may carry this gene mutation and pass it to their children.
The most common causes of secondary hypertrophic osteoarthropathy are lung diseases. When lung diseases cause this condition, the name of the condition is hypertrophic pulmonary osteoarthropathy (HPOA).
The most common lung disease that causes HPOA is lung cancer, especially non-small cell lung cancer. Other lung diseases that cause HPOA include:
Other causes of secondary hypertrophic osteoarthropathy include:
Conditions of the liver, bile, bile ducts and gallbladder (hepatobiliary conditions) that cause SHO include:
Heart diseases that cause SHO include:
Gastrointestinal conditions that cause SHO include:
Other conditions that cause SHO include:
The main symptom of hypertrophic osteoarthropathy is clubbing of your fingers, toes or both. The clubbing usually affects both sides of the body equally. You may see:
Other HOA symptoms may include:
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In addition to the same general HOA symptoms, secondary hypertrophic osteoarthropathy symptoms may include swollen joints (joint effusions). Extra fluid builds up in the tissues in and around your joints. Joint effusions can cause:
Joint effusion related to SHO tends to occur in the knees and wrists.
Your healthcare provider will first look for clubbing on your fingers or toes. They will also do a physical exam to look for:
If your provider suspects hypertrophic osteoarthropathy, they will use tests such as:
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If your healthcare provider suspects that hypertrophic osteoarthropathy has an underlying medical cause, they may suggest tests such as:
These tests can help your provider to figure out the cause of the HOA. If an imaging test shows any growths, your provider may also suggest a biopsy. This can help them determine the cause of the growth.
You may not need treatment for primary hypertrophic osteoarthropathy unless you experience pain or symptoms worsen. Treatments may include medications such as:
Treatments for secondary hypertrophic osteoarthropathy also include management of the underlying cause. Treatments may include:
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If your provider can’t treat the underlying cause of SHO, they may suggest treatment of symptoms with medications.
Results will depend on the type of hypertrophic osteoarthropathy you have, the severity of your condition and the treatment you use. Once your provider treats your underlying condition, the clubbing may go away quickly.
You can’t reduce your risk of primary hypertrophic osteoarthropathy because it’s an inherited form of HOA.
You can reduce your risk of SHO by leading a healthy lifestyle, especially if you’re at risk for heart or lung problems. Steps you can take include:
Primary hypertrophic osteoarthropathy may stop getting worse on its own. It sometimes goes away completely, especially after adolescence.
Secondary hypertrophic osteoarthropathy can go away completely after treatment for the underlying cause. But if your provider can’t successfully treat the underlying cause, you’ll continue to have SHO. For instance, providers may be unsuccessful in treating SHO related to aggressive cancer.
If you have hypertrophic osteoarthropathy for a long time, you may experience:
But you can manage many symptoms with proper treatments.
You can take care of yourself with HOA by continuing with any treatments that help to control your symptoms.
See your provider if you notice any symptoms of clubbing coming back after treatment. This may indicate a return of the underlying condition.
Also, see your provider with any concerns about side effects from your treatments or if you don’t notice any results after some time. They’ll be able to suggest other treatments that may help.
A note from Cleveland Clinic
Hypertrophic osteoarthropathy (HOA) is a condition that leads to clubbing of the fingers or toes. Genetics cause primary hypertrophic osteoarthropathy (PHO), while underlying health conditions, especially lung and heart conditions, cause secondary hypertrophic osteoarthropathy (SHO). Besides clubbing, other symptoms may include tender ankles, knees or wrists, swollen legs and thickened facial skin.
Providers diagnose HOA with a physical exam and specific tests. Treatments for PHO include medications to manage symptoms. But treatments for SHO focus on treating the underlying condition. PHO may stop progressing or resolve on its own. The outlook for SHO depends on whether treatment for the underlying condition is successful.
Last reviewed on 09/08/2022.
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