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April 18, 1986, Vol 255, No. 15 >
ARTICLE | April 18, 1986

Acro-osteolysis: Title and subTitle BreakEtiologic and Radiological Considerations FREE

Susan S. Kemp, MD; Murray K. Dalinka, MD; H. Ralph Schumacher, MD
[+] Author Affiliations

Reprint requests to the Department of Radiology, Hospital of the University of Pennsylvania, 3400 Spruce St, Philadelphia, PA 19104 (Dr Dalinka).


JAMA. 1986;255(15):2058-2061. doi:10.1001/jama.1986.03370150100036
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References

THE TERM acro-osteolysis refers to a destructive process involving one or more terminal phalanges. Distal phalangeal destruction usually occurs in association with a variety of systemic diseases or as a result of local factors (Table); a hereditary form also exists.

Variations in the radiological appearance of acro-osteolysis, depending on the area of the terminal phalanx involved, can be of help in suggesting different etiologies.1 Resorption of the tips of the ungual tufts with variable involvement of the shafts and bases (sometimes termed acronecrosis2) may be observed in hyperparathyroidism, psoriasis, neurological disorders, and frostbite. Destruction of the proximal end of the distal phalanx by extension from disease of the distal interphalangeal joint occurs in psoriasis, rheumatoid arthritis, erosive osteoarthritis, and other rheumatic diseases. A transverse band of osteolysis may be noted in the shaft of the distal phalanx, leaving the tuft and proximal articular portion intact. This finding may

REFERENCES

1 +
McAfee JG, Donner MW:  Differential diagnosis of radiographic changes in the hands . Am J Med Sci 1963;;245:604-635.
2 +
Destouet JM, Murphy WA:  Acquired acroosteolysis and acronecrosis . Arthritis Rheum 1983;;26:1150-1154.
3 +
Miller JL, Soltani K, Tourtellotee CD:  Psoriatic acro-osteolysis without arthritis . J Bone Joint Surg Am 1971;;53:371-374.
4 +
Bunch TW, O'Duffy JD, McLeod RA:  Deforming arthritis of the hands in polymyositis . Arthritis Rheum 1976;;19:243-247.
5 +
Resnick D, Niwayama G (eds): Diagnosis of Bone and Joint Disorders . Philadelphia, WB Saunders Co, 1981;.
6 +
James DG, Neville E, Carstairs LS:  Bone and joint sarcoidosis . Semin Arthritis Rheum 1976;;6:53-81.
7 +
Peter JB, Pearson CM, Marmor L:  Erosive osteoarthritis of the hands . Arthritis Rheum 1966;;9:365-388.
8 +
Gold RH, Metzger AL, Mirra JM, et al:  Multicentric reticulohistiocytosis (lipoid dermato-arthritis) . AJR 1975;;124:610-624.
9 +
Mills PR, Vallance R, Birnie G, et al:  A prospective survey of radiological bone and joint changes in primary biliary cirrhosis . Clin Radiol 1981;;32:297-302.
10 +
Rohlfing BM, Basch GM, Genant HK:  Acro-osteolysis as the sole skeletal manifestation of rheumatoid vasculitis . Br J Radiol 1977;; 50:830-832.
11 +
Higgins CB, Hayden WG:  Palmar arteriography in acronecrosis . Radiology 1976;;119:85-90.
12 +
Sundaram M, Joyce PF, Shields JB, et al:  Terminal phalangeal tufts: Earliest site of renal osteodystrophy findings in hemodialysis patients . AJR 1979;;133:25-29.
13 +
Gama C, Meira JB:  Occupational acroosteolysis . J Bone Joint Surg Am 1978;;60:86-90.
14 +
Grainger RG, Walker AE, Ward AM:  Vinyl chloride monomer-induced disease: Clinical, radiological and immunological aspects , in Prega L (ed): Induced Disease: Drug, Irradiation, Occupational . New York, Grune & Stratton, 1979;, pp 191-214.
15 +
Destouet JM, Murphy WA:  Guitar player acro-osteolysis . Skeletal Radiol 1981;;6:275-277.
16 +
Enna CD, Jacobson RR, Rausch RO:  Bone changes in leprosy: A correlation of clinical and radiographic features . Radiology 1971;;100:295-306.
17 +
Cheyney WA:  Acro-osteolysis . AJR 1965;; 94:595-607.
18 +
Elias AN, Pinals RS, Anderson HC, et al:  Hereditary osteodysplasia with acro-osteolysis (the Hadju-Cheyney syndrome) . Am J Med 1978;; 62:627-636.
19 +
Gilula LA, Bliznak J, Staple TW:  Idiopathic nonfamilial acro-osteolysis with cortical defects and mandibular ramus osteolysis . Radiology 1976;;121:63-68.
20 +
Reeder M, Felson B: Gamuts in Radiology . Audiovisual Radiology of Cincinnati Inc, 1975;.
21 +
McCormick CC:  Case report 20 . Skeletal Radiol 1977;;1:183.
22 +
Vidal JJ, Ruiz J, Santiago T, et al:  Case report 106 . Skeletal Radiol 1979;;4:251-252.
23 +
Fernbach SK, Poznonski AK:  Case report 231 . Skeletal Radiol 1983;;10:43-45.

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1 +
McAfee JG, Donner MW:  Differential diagnosis of radiographic changes in the hands . Am J Med Sci 1963;;245:604-635.
2 +
Destouet JM, Murphy WA:  Acquired acroosteolysis and acronecrosis . Arthritis Rheum 1983;;26:1150-1154.
3 +
Miller JL, Soltani K, Tourtellotee CD:  Psoriatic acro-osteolysis without arthritis . J Bone Joint Surg Am 1971;;53:371-374.
4 +
Bunch TW, O'Duffy JD, McLeod RA:  Deforming arthritis of the hands in polymyositis . Arthritis Rheum 1976;;19:243-247.
5 +
Resnick D, Niwayama G (eds): Diagnosis of Bone and Joint Disorders . Philadelphia, WB Saunders Co, 1981;.
6 +
James DG, Neville E, Carstairs LS:  Bone and joint sarcoidosis . Semin Arthritis Rheum 1976;;6:53-81.
7 +
Peter JB, Pearson CM, Marmor L:  Erosive osteoarthritis of the hands . Arthritis Rheum 1966;;9:365-388.
8 +
Gold RH, Metzger AL, Mirra JM, et al:  Multicentric reticulohistiocytosis (lipoid dermato-arthritis) . AJR 1975;;124:610-624.
9 +
Mills PR, Vallance R, Birnie G, et al:  A prospective survey of radiological bone and joint changes in primary biliary cirrhosis . Clin Radiol 1981;;32:297-302.
10 +
Rohlfing BM, Basch GM, Genant HK:  Acro-osteolysis as the sole skeletal manifestation of rheumatoid vasculitis . Br J Radiol 1977;; 50:830-832.
11 +
Higgins CB, Hayden WG:  Palmar arteriography in acronecrosis . Radiology 1976;;119:85-90.
12 +
Sundaram M, Joyce PF, Shields JB, et al:  Terminal phalangeal tufts: Earliest site of renal osteodystrophy findings in hemodialysis patients . AJR 1979;;133:25-29.
13 +
Gama C, Meira JB:  Occupational acroosteolysis . J Bone Joint Surg Am 1978;;60:86-90.
14 +
Grainger RG, Walker AE, Ward AM:  Vinyl chloride monomer-induced disease: Clinical, radiological and immunological aspects , in Prega L (ed): Induced Disease: Drug, Irradiation, Occupational . New York, Grune & Stratton, 1979;, pp 191-214.
15 +
Destouet JM, Murphy WA:  Guitar player acro-osteolysis . Skeletal Radiol 1981;;6:275-277.
16 +
Enna CD, Jacobson RR, Rausch RO:  Bone changes in leprosy: A correlation of clinical and radiographic features . Radiology 1971;;100:295-306.
17 +
Cheyney WA:  Acro-osteolysis . AJR 1965;; 94:595-607.
18 +
Elias AN, Pinals RS, Anderson HC, et al:  Hereditary osteodysplasia with acro-osteolysis (the Hadju-Cheyney syndrome) . Am J Med 1978;; 62:627-636.
19 +
Gilula LA, Bliznak J, Staple TW:  Idiopathic nonfamilial acro-osteolysis with cortical defects and mandibular ramus osteolysis . Radiology 1976;;121:63-68.
20 +
Reeder M, Felson B: Gamuts in Radiology . Audiovisual Radiology of Cincinnati Inc, 1975;.
21 +
McCormick CC:  Case report 20 . Skeletal Radiol 1977;;1:183.
22 +
Vidal JJ, Ruiz J, Santiago T, et al:  Case report 106 . Skeletal Radiol 1979;;4:251-252.
23 +
Fernbach SK, Poznonski AK:  Case report 231 . Skeletal Radiol 1983;;10:43-45.

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