Multifocal Periostitis in Adults

• Venous stasis: Lower extremities.
• Hypertrophic osteoarthropathy: Either primary (pachydermoperiostosis) or secondary (pulmonary hypertrophic osteoarthropathy). Both are symptomatic and involve the distal portions of the long tubular bones, typically at the wrist and ankle.
• Thyroid acropachy: Asymptomatic periostitis seen in autoimmune thyroid disease, including about 1% of patients with Graves disease. Metacarpals, metatarsals and phalanges are involved. The long bones are less likely to be involved. The classic pattern is periostitis along the radial side of the first through third digits and the ulnar side of the fourth and fifth digits. Look for clubbing and soft tissue swelling in the digits. Pretibial myxedema, dermopathy, and other signs of thyroid disease may also be present. Dermopathy and acropachy are markers for severe thyroid ophthalmopathy.

See related post on periostitis in children.