Arthralgia as a first symptom of pulmonary lesions.

It is the purpose of this communication to emphasize that arthralgia may be the earliest manifestation of hypertrophic pulmonary osteoarthropathy and consequently, at times, the earliest symptom of intrathoracic disease. That clubbing of the fingers is an early manifestation of hypertrophic pulmonary osteoarthropathy was suggested by Marie’ in 1890, Bamberger2 In 1891, and shortly after by Lefebvre,3 Thompson,4 Landis,5 and others. Locke,6 in 1915, determined conclusively that clubbed fingers are an early phase of hypertrophic pulmonary osteoarthropathy. “Simple clubbing of the fingers and secondary hypertrophic osteoarthropathy should be considered as identical, the former representing an early stage of the latter.” He reinterated that in the majority of instances hypertrophic osteoarthropathy is secondary to a primary pathological process involving the organs of the thorax. Van Hazel,7 in 1940, stressed the fact that joint manifestations, when occurring rapidly, in the absence of pulmonary symptoms, may be interpreted as arthritis. This error precludes an early diagnosis of the pulmonary pathology which may be a malignant neoplasm. Pain, although not always present in pulmonary osteoarthropathy, may be the first symptom of the process. This is of extreme diagnostic importance. Regarding this important point, the literature is deficient. Craig,8 Nef,9 Van Hazel,7 and Pavlovsky’#{176} are among the few who have made the correlation.