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April 18, 1986

Acro-osteolysis: Etiologic and Radiological Considerations

Author Affiliations

From the Department of Radiology (Drs Kemp and Dalinka) and the Rheumatology Section, Department of Medicine (Dr Schumacher), Hospital of the University of Pennsylvania, Philadelphia; and the Veterans Administration Medical Center, Philadelphia (Dr Schumacher).

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

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