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Age and Ageing Advance Access originally published online on January 24, 2007
Age and Ageing 2007 36(2):229; doi:10.1093/ageing/afl166
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Copyright © The Author 2007. Published by Oxford University Press on behalf of the British Geriatrics Society.

Clinical Reminders

Mono-osteotic Paget's disease of the hand

Abhay Kumar Das* and Konstantin Schwarz

Pontefract General Infirmary, Medicine for the Elderly, Pontefract, West Yorkshire, UK

* To whom correspondence should be addressed abhaylopa{at}yahoo.co.uk

An 85-year-old lady presented with a painful swollen left hand. X-ray revealed an expanding 4th metacarpal as in Figure 1 with homogeneous sclerosis and areas of lucencies characteristic of Paget's disease. The rest of the radiological skeletal survey and the bone biochemistry profile were normal. The pain eased with ibuprofen.


Figure 1
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  		Figure 1. Paget's disease involving 4th metacarpal bone.

 
Paget's disease commonly involves multiple large bones of elderly people. Mono-osteotic involvement of hand has been only infrequently reported [1]. While phalanges are usually affected, metacarpal and carpal bones are rarely involved [2]. Usually, it is discovered incidentally on radiographs; however, some patients present with pain, swelling and rarely with pathological fractures [2, 3]. Total alkaline phosphatase is raised only when larger bones are affected [4] and in such cases bisphosphonates are useful to reduce bone turnover and relieve pain [5]. Anti-inflammatory agents are also indicated for pain relief. This disease needs to be considered in the differential diagnosis of expansile, subchondral lesions of the hand in the elderly.


   Conflicts of Interest
 
There are no Conflicts of Interest.


   References
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 References
 

  1. Rodriguez-Peralto JL, Ro JY, McCabe KM, et al. (1994) Case report 806. Skeletal Radiol 23 55–7.[Web of Science][Medline]
  2. Friedman AC, Orcutt J, Madewell JE. (1982) Paget's disease of the hand: radiographic spectrum. AJR 138 691–3.[Abstract/Free Full Text]
  3. Ogilvie-Harris DJ and Fornasier VL. (1979) Pathologic fractures of the hand in Paget's disease. Clin Orthop Relat Res 143 168–70.
  4. Alvarez L, Guañabens N, Peris P, et al. (1995) Discriminative value of biochemical markers of bone turnover in assessing the activity of Paget's disease. J Bone Miner Res 10 458–65.[Web of Science][Medline]
  5. Langston AL and Ralston SH. (2004) Management of Paget's disease of bone. Rheumatology 43 955–9.[Abstract/Free Full Text]

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This Article
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