Images in Clinical Rheumatology
A man with Garrod’s pads and camptodactyly
Varón con nódulos de Garrod y camptodactilia
Carolina Diez Morrondo
, Lucía Pantoja Zarza
Corresponding author
Servicio de Reumatología, Hospital El Bierzo, Ponferrada, León, Spain
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Además de los nódulos de Garrod se observa una contractura en flexión de la interfalángica proximal del quinto dedo de la mano, conocida como camptodactilia (flecha blanca). Cuando esta asociación se presenta conviene descartar síndromes genéticos asociados. Asimismo, recordar que la camptodactilia se ha descrito asociada a artritis y a pericarditis constrictiva.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Carolina Diez Morrondo, Lucía Pantoja Zarza" "autores" => array:2 [ 0 => array:2 [ "nombre" => "Carolina" "apellidos" => "Diez Morrondo" ] 1 => array:2 [ "nombre" => "Lucía" "apellidos" => "Pantoja Zarza" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S2173574319300620" "doi" => "10.1016/j.reumae.2018.01.010" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173574319300620?idApp=UINPBA00004M" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1699258X18300317?idApp=UINPBA00004M" "url" => "/1699258X/00000016000002P2/v1_202005111112/S1699258X18300317/v1_202005111112/es/main.assets" ] ] "itemSiguiente" => array:19 [ "pii" => "S217357431930070X" "issn" => "21735743" "doi" => "10.1016/j.reumae.2018.02.006" "estado" => "S300" "fechaPublicacion" => "2020-03-01" "aid" => "1200" "copyright" => "Elsevier España, S.L.U. and Sociedad Española de Reumatología y Colegio Mexicano de Reumatología" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "cor" "cita" => "Reumatol Clin. 2020;16:187-8" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "en" => array:10 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Letter to the Editor</span>" "titulo" => "Switch from intravenous to subcutaneous abatacept: Our experience" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "187" "paginaFinal" => "188" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Cambio de abatacept intravenoso a subcutáneo: experiencia de nuestro centro" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Juan Carlos Nieto-González, Juan G. 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In addition to the Garrod pads a proximal interphalangeal joint flexion contracture of the fifth finger can be seen, known as camptodactyly (white arrow). When this association presents, associated genetic syndromes should be ruled out. Likewise, we should remember that camptodactyly has been described associated with arthritis and constrictive pericarditis.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Clinical case</span><p id="par0005" class="elsevierStylePara elsevierViewall">We present the case of a 40-year-old male with no other personal or family history of interest who consulted with a 3-year history of nodules of a soft consistency on the dorsal surface of the proximal interphalangeal joints (PIPJ) of both hands (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). He reported no pain or restricted mobility; physical examination did not reveal synovitis. Our attention was drawn to a proximal interphalangeal joint flexion contracture of the fifth finger of the right hand (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). The dermatology department was consulted, and the clinical suspicion of Garrod pads was confirmed. We decided not to prescribe any treatment because these are asymptomatic lesions.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Discussion</span><p id="par0010" class="elsevierStylePara elsevierViewall">Knuckle or Garrod pads are a type of digital fibromatosis characterised as asymptomatic papular or nodular lesions seated on the dorsal surface of the PIPJ or, less often, the metacarpophalangeal joints.<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">1–4</span></a> Since they can be confused with synovitis, it is important for the rheumatologist to be aware of them.<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">1,4</span></a> Their aetiology is usually idiopathic or relating to repeated trauma.<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">1,3</span></a> They can be hereditary, and associated with autosomal dominant hereditary diseases such as Peyronie's disease, Bart–Pumphrey syndrome or Dupuytren's disease.<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">1,3</span></a> Likewise, such as the patient in this study, Garrod pads have been described in combination with camptodactyly (flexion contracture of a finger, usually the fifth digit).<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">4–7</span></a> When this association presents, associated genetic syndromes should be discounted.<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">5–8</span></a> We would also highlight that camptodactyly has been described associated with arthritis and constrictive pericarditis.<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">8</span></a> Although diagnosis is usually clinical, histological study will reveal epidermal hyperplasia with hyperkeratosis, fibroblastic proliferation, and absence of inflammatory infiltrate.<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">1,3</span></a> With regard to treatment, given the benign nature of the condition, many authors advocate therapeutic abstention.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">1</span></a> Nevertheless, in some cases topical glucocorticoids and keratolytic agents have been used, and even surgical removal.<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">1,3</span></a></p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Conflict of interests</span><p id="par0015" class="elsevierStylePara elsevierViewall">The authors have no conflict of interests to declare.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:4 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Clinical case" ] 1 => array:2 [ "identificador" => "sec0010" "titulo" => "Discussion" ] 2 => array:2 [ "identificador" => "sec0015" "titulo" => "Conflict of interests" ] 3 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2017-12-20" "fechaAceptado" => "2018-01-15" "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Diez Morrondo C, Pantoja Zarza L. Varón con nódulos de Garrod y camptodactilia. Reumatol Clin. 2020;16:185–186.</p>" ] ] "multimedia" => array:1 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 714 "Ancho" => 900 "Tamanyo" => 85869 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Painless nodules of a soft consistency on the back of the proximal interphalangeal joints of the hand, termed Garrod pads (black arrows). In addition to the Garrod pads a proximal interphalangeal joint flexion contracture of the fifth finger can be seen, known as camptodactyly (white arrow). When this association presents, associated genetic syndromes should be ruled out. Likewise, we should remember that camptodactyly has been described associated with arthritis and constrictive pericarditis.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:8 [ 0 => array:3 [ "identificador" => "bib0045" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Nódulos de Garrod" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "S. Rodríguez-Muguruza" 1 => "A. Riveros" 2 => "J. Sanint" 3 => "A. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 October | 141 | 32 | 173 |
| 2024 September | 220 | 36 | 256 |
| 2024 August | 205 | 59 | 264 |
| 2024 July | 145 | 46 | 191 |
| 2024 June | 144 | 46 | 190 |
| 2024 May | 110 | 35 | 145 |
| 2024 April | 117 | 41 | 158 |
| 2024 March | 98 | 29 | 127 |
| 2024 February | 125 | 34 | 159 |
| 2024 January | 136 | 25 | 161 |
| 2023 December | 149 | 20 | 169 |
| 2023 November | 184 | 39 | 223 |
| 2023 October | 199 | 41 | 240 |
| 2023 September | 169 | 50 | 219 |
| 2023 August | 195 | 29 | 224 |
| 2023 July | 171 | 31 | 202 |
| 2023 June | 188 | 34 | 222 |
| 2023 May | 187 | 25 | 212 |
| 2023 April | 166 | 12 | 178 |
| 2023 March | 226 | 28 | 254 |
| 2023 February | 224 | 30 | 254 |
| 2023 January | 160 | 22 | 182 |
| 2022 December | 186 | 34 | 220 |
| 2022 November | 223 | 35 | 258 |
| 2022 October | 238 | 43 | 281 |
| 2022 September | 192 | 39 | 231 |
| 2022 August | 230 | 40 | 270 |
| 2022 July | 211 | 42 | 253 |
| 2022 June | 247 | 40 | 287 |
| 2022 May | 274 | 45 | 319 |
| 2022 April | 304 | 42 | 346 |
| 2022 March | 330 | 52 | 382 |
| 2022 February | 349 | 32 | 381 |
| 2022 January | 378 | 48 | 426 |
| 2021 December | 321 | 47 | 368 |
| 2021 November | 285 | 40 | 325 |
| 2021 October | 468 | 55 | 523 |
| 2021 September | 316 | 44 | 360 |
| 2021 August | 312 | 33 | 345 |
| 2021 July | 555 | 30 | 585 |
| 2021 June | 303 | 32 | 335 |
| 2021 May | 319 | 55 | 374 |
| 2021 April | 705 | 92 | 797 |
| 2021 March | 416 | 25 | 441 |
| 2021 February | 278 | 13 | 291 |
| 2021 January | 150 | 15 | 165 |
| 2020 December | 66 | 15 | 81 |
| 2020 November | 41 | 23 | 64 |
| 2020 October | 27 | 9 | 36 |
| 2020 September | 28 | 14 | 42 |
| 2019 May | 1 | 0 | 1 |
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