Rapid responses are electronic comments to the editor. They enable our users to debate issues raised in articles published on bmj.com. A rapid response is first posted online. If you need the URL (web address) of an individual response, simply click on the response headline and copy the URL from the browser window. A proportion of responses will, after editing, be published online and in the print journal as letters, which are indexed in PubMed. Rapid responses are not indexed in PubMed and they are not journal articles. The BMJ reserves the right to remove responses which are being wilfully misrepresented as published articles.
Bone changes affect primarily the priximal phalanges associated with painful enlargement and when the ends of the fingers and toes become thickened and bulbous as seen in this patient along with symptoms of peripheral arthropthy overwhelmed by thickening of the skin are most likely features of "Pachydermoperiostosis". The clubbing is produced by soft tissue hyperplasia associated with diffuse irregular periosteal ossification which leads to increases the circumference of the affected bones. In this patient the abnormality is symmmetrical i.e suggestive of being under the scope of syndromic entity. The current patient needs a better clinical documentation.