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Paraneoplastic musculoskeletal disorders: review and update for radiologists. Skeletal Radiol 2023; 52:421-433. [PMID: 35604445 DOI: 10.1007/s00256-022-04074-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 05/11/2022] [Accepted: 05/12/2022] [Indexed: 02/02/2023]
Abstract
Rheumatic paraneoplastic syndromes are rare syndromes that occur at distant sites from the underlying tumor and may involve the bones, joints, fasciae, muscles, or vessels. In the absence of a known tumor, early recognition of a rheumatic syndrome as paraneoplastic permits dedicated work-up for, and potentially early treatment of an occult malignancy. Although there is a continuously growing list of paraneoplastic rheumatic disorders, not all of these disorders have a well-established association with a neoplastic process. The goals of this article are to review the clinical characteristics, diagnostic work-up, and imaging findings of well-documented rheumatic paraneoplastic disorders.
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Paraneoplastic Syndromes in Patients with Keratinocyte Skin Cancer. Cancers (Basel) 2022; 14:cancers14010249. [PMID: 35008413 PMCID: PMC8750284 DOI: 10.3390/cancers14010249] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 12/25/2021] [Accepted: 01/02/2022] [Indexed: 01/19/2023] Open
Abstract
Simple Summary The aim of the present review is to compile and evaluate the literature data on paraneoplastic syndromes (PNS) associated with keratinocyte skin cancer (KSC). Forty relevant entries were assembled, reporting a total of 41 PNS cases associated with a KSC (34 male). No review paper compiling this topic was found. Six distinct PNS entities were identified, and malignancy associated hypercalcemia (MAH; 78%), anemia (10%) and Bazex syndrome (5%) were the most frequently reported among them. 85% of the PNS were reported in association with SCC, 10% with BCC, and the rest with adnexal tumors. The median age of the patients at the time of PNS diagnosis was 58 years (range: five–83 years). KSC predisposing conditions, as scars (22%) or hidradenitis suppurativa (20%), were reported in >70% of the PNS cases. In conclusion, PNS are rarely reported in association with KSC, possibly reflecting a limited capacity of KSC to provoke overt PNS. Abstract A variety of well-characterized cutaneous paraneoplastic syndromes (PNS) are diagnosed during internal malignancies; however, the spectrum of keratinocyte skin neoplasms (KSC) related to PNS is still obscure. The aim of the present review is to compile and evaluate the literature data on PNS associated with a keratinocyte skin neoplasm (KSC). Employing Pubmed, MEDLINE was searched for KSC-associated PNS reports. Forty relevant entries were assembled, reporting a total of 41 PNS cases associated with a KSC (34 male). No review paper compiling this topic was found. Six distinct PNS entities were identified, and malignancy associated hypercalcemia (MAH; 78%), anemia (10%) and Bazex syndrome (5%) were the most frequently reported among them. 85% of the PNS were reported in association with SCC, 10% with BCC, and the rest with adnexal tumors. The median age of the patients at the time of PNS diagnosis was 58 years (range: five–83 years). In most cases the PNS was diagnosed either concurrently or after the KSC diagnosis. KSC predisposing conditions, as scars (22%) or hidradenitis suppurativa (20%), were reported in >70% of the PNS cases. Most PNS resolved after KSC treatment. In conclusion, PNS of a rather limited spectrum of entities are reported in association with KSC. They also seem to be rare, possibly reflecting a limited capacity of KSC to provoke overt PNS.
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Parperis K, Constantinidou A, Panos G. Paraneoplastic Arthritides: Insights to Pathogenesis, Diagnostic Approach, and Treatment. J Clin Rheumatol 2021; 27:e505-e509. [PMID: 31743270 DOI: 10.1097/rhu.0000000000001202] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
ABSTRACT Paraneoplastic arthritides are a group of inflammatory rheumatic syndromes induced by an occult and manifest malignancy, characterized by a wide range of musculoskeletal signs and symptoms that masquerade other rheumatic diseases such as rheumatoid arthritis. Although the pathogenesis of paraneoplastic arthritides is unknown, immune-mediated mechanisms can induce a paraneoplastic syndrome, with a dominant feature the polyarthritis. Common entities of paraneoplastic arthritides include paraneoplastic polyarthritis, hypertrophic osteoarthropathy, remitting seronegative symmetrical synovitis with pitting edema, palmar fasciitis and polyarthritis, and polyarthritis and panniculitis associated with pancreatic carcinoma. The electronic databases PubMed and Scopus were scrutinized using the following terms: paraneoplastic arthritis, paraneoplastic polyarthritis, or paraneoplastic rheumatic diseases. Abstracts, full articles, and selected references were reviewed. The aim of the present narrative review article was to describe the clinical characteristics, diagnostic evaluation, and management of paraneoplastic arthritides, and highlight the challenges that health care providers may encounter, distinguishing those conditions from other autoimmune rheumatic disorders. Future studies are needed to give insight into the mechanisms associated with paraneoplastic arthritides, leading to the development of novel diagnostic biomarkers.
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Affiliation(s)
- Konstantinos Parperis
- From the Division of Rheumatology, Department of Internal Medicine, University of Arizona College of Medicine/Maricopa Integrated Health System, Phoenix, AZ; and University of Cyprus Medical School
| | | | - George Panos
- Department of Internal Medicine, University of Cyprus Medical School, Nicosia, Cyprus
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Cho Y, Anderson EW, Guevara SJ, Miyara SJ, Maria N, Metz CN, Zafeiropoulos S, Giannis D, Wang J, Abidoye O, Mumford JM, Aronsohn J, Molmenti E, Sohail H. Diagnostic Dilemma of Paraneoplastic Rheumatic Disorders: Case Series and Narrative Review. Cureus 2021; 13:e19993. [PMID: 34984145 PMCID: PMC8715838 DOI: 10.7759/cureus.19993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/29/2021] [Indexed: 11/27/2022] Open
Abstract
Paraneoplastic rheumatic disorder (RD) is a disorder that may present before, concurrent with, or after the diagnosis of malignancy. Paraneoplastic RDs are a clinical expression of occult cancer that is not directly related to a tumor or metastasis and manifests as rheumatoid symptoms. The RD is determined by the organ system affected by articular, muscular, cutaneous, vascular, or miscellaneous symptoms. Each case is challenging to diagnose because cancer may present with similar symptoms as a common rheumatic disorder. Of note, the majority of cases have minimal responsiveness or no responsiveness to standard rheumatoid treatment. Therefore, it is imperative to recognize and treat the underlying cancer accordingly. Herein, we present four different diagnostic dilemma cases of RD: case #1 - leukocytoclastic vasculitis and C3 glomerulopathy, case #2 - scleroderma, case #3 - Raynaud’s syndrome and possible lupus-like syndrome, and case #4 - inflammatory myositis. Institutional IRB approval was obtained for this case series. We will discuss and review the literature on each topic. In addition, we will mention a review of paraneoplastic rheumatoid arthritis. As rheumatic disease is associated with the use of immune checkpoint inhibitors (ICIs) for cancer treatment, we will briefly discuss some of the most common rheumatic presentations in the setting of these drugs. This case review aims to inform clinicians about the atypical presentation of paraneoplastic RD and to highlight the need for interdisciplinary management between rheumatologists, oncologists, and primary care practitioners.
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Uchida T, Matsubara H, Ohnuki Y, Sugimura A, Matsuoka H, Ichihara T, Nakajima H. Ciliated muconodular papillary tumor of the lung presenting with polymyalgia rheumatica-like symptoms: a case report. AME Case Rep 2019; 3:37. [PMID: 31728435 DOI: 10.21037/acr.2019.09.06] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Accepted: 09/16/2019] [Indexed: 11/06/2022]
Abstract
Ciliated muconodular papillary tumors (CMPTs) of the lung have been recently characterized as low-grade malignant tumors and may be indistinguishable from adenocarcinoma in situ (AIS) because they are both abundant in mucous and spread along the alveolar walls. Herein, we report a case of CMPT with polymyalgia rheumatica (PMR)-like symptoms, which resolved after resection. After the surgery, antinuclear antibody tests were performed, but no abnormalities were noted. Furthermore, the lung tumor could not be distinguished from AIS, as revealed by a pathological examination. This case demonstrates two key points: the paraneoplastic symptoms of CMPT can indicate PMR, and it is difficult to diagnose peripheral lung tumors as CMPT unless there is a completely resected specimen available. The possibility exists that an increased number of older patients will be diagnosed with CMPT because of the increasing frequency of computed tomography performed in this population. Therefore, it is important for clinicians to obtain completely resected specimens to ensure accurate diagnosis and management of CMPT.
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Affiliation(s)
- Tsuyoshi Uchida
- Department of General Thoracic Surgery, Yamanashi University, Yamanashi, Japan
| | - Hirochika Matsubara
- Department of General Thoracic Surgery, Yamanashi University, Yamanashi, Japan
| | - Yuuichirou Ohnuki
- Department of General Thoracic Surgery, Yamanashi University, Yamanashi, Japan
| | - Aya Sugimura
- Department of General Thoracic Surgery, Yamanashi University, Yamanashi, Japan
| | - Hiroyasu Matsuoka
- Department of General Thoracic Surgery, Yamanashi University, Yamanashi, Japan
| | - Tomofumi Ichihara
- Department of General Thoracic Surgery, Yamanashi University, Yamanashi, Japan
| | - Hiroyuki Nakajima
- Department of General Thoracic Surgery, Yamanashi University, Yamanashi, Japan
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Wen J, Ouyang H, Yang R, Bo L, Zhang Y, Tang M, Liu Z. Malignancy dominated with rheumatic manifestations: A retrospective single-center analysis. Sci Rep 2018; 8:1786. [PMID: 29379092 PMCID: PMC5789019 DOI: 10.1038/s41598-018-20167-w] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Accepted: 01/15/2018] [Indexed: 12/27/2022] Open
Abstract
Paraneoplastic rheumatic syndromes comprise a heterogeneous group of disorders characterized by typical rheumatic manifestations but without direct invasion by the tumor or metastases. The clinical features and malignancy-associated risk factors of 21 patients with paraneoplastic rheumatic syndromes, including 11 men and 10 women with a mean age of 56.3 ± 13.1 years, were characterized by a retrospective review. All patients were diagnosed with malignancy within 2 years of rheumatism diagnosis. Patients suffering from solid malignancies accounted for the majority (62%); hematological malignancies were observed in the remainder. Arthritis (48%), lymph node enlargement (38%), skin rash (38%), weight loss (29%), fever/chills (24%), fatigue (24%), muscle soreness (24%) and smoking history (29%) were common findings. Except for 8 patients (38%) who tested positive for anti-nuclear antibody (ANA) and 9 positive for rheumatoid factor (RF), all patients tested negative for anti-extractable nuclear antigen (ENA) antibodies. Rheumatic disorders with a typical clinical presentation in older patients and nonspecific systemic features should alert clinicians to search for an occult malignancy. Patients with rheumatic disease must be closely followed to screen for malignancies, particularly within 2 years of rheumatism diagnosis.
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Affiliation(s)
- Jian Wen
- Department of Rheumatology and Immunology, The Second Affiliated Hospital of Soochow University, Suzhou, 215004, China
| | - Han Ouyang
- Department of Nephrology, The Second Affiliated Hospital of Soochow University, Suzhou, 215004, China
| | - Ru Yang
- Department of Rheumatology and Immunology, The Second Affiliated Hospital of Soochow University, Suzhou, 215004, China
| | - Lin Bo
- Department of Rheumatology and Immunology, The Second Affiliated Hospital of Soochow University, Suzhou, 215004, China
| | - Yi Zhang
- Department of Rheumatology and Immunology, The Second Affiliated Hospital of Soochow University, Suzhou, 215004, China
| | - Mei Tang
- Department of Rheumatology and Immunology, The Second Affiliated Hospital of Soochow University, Suzhou, 215004, China
| | - Zhichun Liu
- Department of Rheumatology and Immunology, The Second Affiliated Hospital of Soochow University, Suzhou, 215004, China.
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Bellan M, Boggio E, Sola D, Gibbin A, Gualerzi A, Favretto S, Guaschino G, Bonometti R, Pedrazzoli R, Pirisi M, Sainaghi PP. Association between rheumatic diseases and cancer: results from a clinical practice cohort study. Intern Emerg Med 2017; 12:621-627. [PMID: 28181122 DOI: 10.1007/s11739-017-1626-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2016] [Accepted: 01/30/2017] [Indexed: 12/19/2022]
Abstract
The association between cancer and immune-mediated rheumatic conditions is controversial, especially as far as polymyalgia rheumatica (PMR) is concerned. Furthermore, no clinical feature has been shown to be suggestive of a paraneoplastic rheumatic syndrome. With the present study, we aim to address both these issues. The study population comprised N = 1750 patients, including N = 100 with PMR, who attended our tertiary immuno-rheumatology clinic between January 1, 2005 and November 30, 2012. A rheumatic disease was deemed paraneoplastic if cancer had been diagnosed in the 2 years preceding or following its onset. The probability of a significant association between a specific rheumatic disease and cancer was evaluated by computing the odds ratio (OR): N = 702 patients with osteoarthritis serving as controls. Furthermore, clinical features distinguishing paraneoplastic rheumatic diseases were searched for by univariate and multivariate analysis. Sjogren's syndrome (SS) [OR 3.6 (CI 95% 1.7-7.5)], PMR (OR 5.1 CI 95% 2.9-8.9), dermatomyositis/polymyositis [OR 12.09 (CI 95% 2.6-55.8)] and vasculitis [OR 3.70 (CI 95% 1.81-7.52)] are associated with cancer. At multivariate analysis, older age is associated with cancer among SS patients (p = 0.03), while in the PMR group, older age, male gender, and ≥6 tender joints are independent predictors of paraneoplastic PMR (p < 0.0004). Cancer frequently either heralds or follows rheumatic manifestations, including PMR. Older age, male gender and a more extensive joint involvement should be considered red flags for paraneoplastic PMR.
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Affiliation(s)
- Mattia Bellan
- Department of Translational Medicine, Università del Piemonte Orientale UPO, Via Solaroli 17, 28100, Novara, NO, Italy.
- Division of Internal Medicine, Immunorheumatology Unit, "Maggiore della Carità" Hospital, Corso Mazzini 18, 28100, Novara, Italy.
| | - Enrico Boggio
- Department of Translational Medicine, Università del Piemonte Orientale UPO, Via Solaroli 17, 28100, Novara, NO, Italy
| | - Daniele Sola
- Department of Translational Medicine, Università del Piemonte Orientale UPO, Via Solaroli 17, 28100, Novara, NO, Italy
- Division of Internal Medicine, Immunorheumatology Unit, "Maggiore della Carità" Hospital, Corso Mazzini 18, 28100, Novara, Italy
| | - Antonello Gibbin
- Department of Translational Medicine, Università del Piemonte Orientale UPO, Via Solaroli 17, 28100, Novara, NO, Italy
- Division of Internal Medicine, Immunorheumatology Unit, "Maggiore della Carità" Hospital, Corso Mazzini 18, 28100, Novara, Italy
| | - Alessandro Gualerzi
- Department of Translational Medicine, Università del Piemonte Orientale UPO, Via Solaroli 17, 28100, Novara, NO, Italy
- Division of Internal Medicine, Immunorheumatology Unit, "Maggiore della Carità" Hospital, Corso Mazzini 18, 28100, Novara, Italy
| | - Serena Favretto
- Department of Translational Medicine, Università del Piemonte Orientale UPO, Via Solaroli 17, 28100, Novara, NO, Italy
- Division of Internal Medicine, Immunorheumatology Unit, "Maggiore della Carità" Hospital, Corso Mazzini 18, 28100, Novara, Italy
| | - Giulia Guaschino
- Department of Translational Medicine, Università del Piemonte Orientale UPO, Via Solaroli 17, 28100, Novara, NO, Italy
- Division of Internal Medicine, Immunorheumatology Unit, "Maggiore della Carità" Hospital, Corso Mazzini 18, 28100, Novara, Italy
| | - Ramona Bonometti
- Department of Translational Medicine, Università del Piemonte Orientale UPO, Via Solaroli 17, 28100, Novara, NO, Italy
- Division of Internal Medicine, Immunorheumatology Unit, "Maggiore della Carità" Hospital, Corso Mazzini 18, 28100, Novara, Italy
| | - Roberta Pedrazzoli
- Division of Internal Medicine, Immunorheumatology Unit, "Maggiore della Carità" Hospital, Corso Mazzini 18, 28100, Novara, Italy
| | - Mario Pirisi
- Department of Translational Medicine, Università del Piemonte Orientale UPO, Via Solaroli 17, 28100, Novara, NO, Italy
- Division of Internal Medicine, Immunorheumatology Unit, "Maggiore della Carità" Hospital, Corso Mazzini 18, 28100, Novara, Italy
- IRCAD, Interdisciplinary Research Center of Autoimmune Diseases, Novara, Italy
| | - Pier Paolo Sainaghi
- Division of Internal Medicine, Immunorheumatology Unit, "Maggiore della Carità" Hospital, Corso Mazzini 18, 28100, Novara, Italy
- IRCAD, Interdisciplinary Research Center of Autoimmune Diseases, Novara, Italy
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Grignano E, Mekinian A, Jachiet V, Coppo P, Fain O. Manifestations auto-immunes et inflammatoires des hémopathies lymphoïdes. Rev Med Interne 2017; 38:374-382. [DOI: 10.1016/j.revmed.2016.10.396] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2016] [Revised: 10/03/2016] [Accepted: 10/27/2016] [Indexed: 10/20/2022]
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9
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Mege D, Cammilleri S, Mundler O, Dignat-George F, Dubois C, Panicot-Dubois L, Guis S. Circulating microparticles bearing Fibrin associated with whole-body 18FDG-PET: diagnostic tools to detect paraneoplastic polymyalgia rheumatica. Rheumatol Int 2016; 36:1099-103. [DOI: 10.1007/s00296-016-3510-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2015] [Accepted: 06/08/2016] [Indexed: 12/15/2022]
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10
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Sondag M, Guillot X, Verhoeven F, Blagosklonov O, Prati C, Boulahdour H, Wendling D. Utility of 18F-fluoro-dexoxyglucose positron emission tomography for the diagnosis of polymyalgia rheumatica: a controlled study. Rheumatology (Oxford) 2016; 55:1452-7. [DOI: 10.1093/rheumatology/kew202] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2015] [Indexed: 01/11/2023] Open
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Schäfer VS, Fleck M, Ehrenstein B, Peters AK, Hartung W. Impact of esophagogastroduodenoscopy and ileocolonoscopy on diagnosis and therapy in patients with rheumatic diseases-a retrospective cohort study. Mod Rheumatol 2016; 26:594-7. [PMID: 26529497 DOI: 10.3109/14397595.2015.1112466] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVES Many rheumatic diseases as well as their medications may cause gastrointestinal (GI) pathologies; in addition, some primary GI diseases may contribute or lead to rheumatic disease manifestations. The aim of this study is to analyze the clinical relevance of esophagogastroduodenoscopy (EGD) and ileocolonoscopy (IC) in patients suffering from inflammatory rheumatic diseases. METHODS A retrospective chart review was performed for all rheumatological inpatients who underwent EGD and/or IC within 2 years. RESULTS Within 2 years, 456 patients (261 female, 195 male) underwent 752 endoscopic investigations of the GI tract (419 EGDs and 333 ICs). Of all patients, 152 (33.3%) did not report any GI complaints. However, 28 of these asymptomatic patients (18.4%) suffered from esophagitis, a gastric ulcer could be identified in 20 patients (13%), whereas unspecific colitis was diagnosed in 19 patients (12.5%). In addition, 14 patients (9.2%) suffered from clinically unapparent Crohn's disease and two patients from Whipple's disease. In one patient with polymyalgia rheumatica, colon cancer was diagnosed. Altogether 304 patients reported GI complaints. Of these, 292 (39%) endoscopic investigations had impact on the final diagnosis or therapeutic strategy. The antirheumatic medication or the concomitant medication was changed in 18% of the patients due to the endoscopic findings; in 29 patients (6.5%) the initially clinically presumed diagnosis had to be corrected. In 70 patients (15%) with an undefined rheumatic diagnosis prior to endoscopy, endoscopic findings were decisive to establish the final diagnosis. CONCLUSION EGD and IC have a high diagnostic impact on patients with rheumatic diseases presenting with or without concomitant GI symptoms.
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Affiliation(s)
- Valentin Sebastian Schäfer
- a Medical Centre for Rheumatology and Clinical Immunology , Immanuel Clinic Berlin-Buch , Berlin , Germany
| | - Martin Fleck
- b Department of Rheumatology and Clinical Immunology , Asklepios Medical Center Bad Abbach , Bad Abbach , Germany , and.,c Department of Internal Medicine (I) , University Medical Center Regensburg , Regensburg , Germany
| | - Boris Ehrenstein
- b Department of Rheumatology and Clinical Immunology , Asklepios Medical Center Bad Abbach , Bad Abbach , Germany , and
| | - Ann-Kathrin Peters
- b Department of Rheumatology and Clinical Immunology , Asklepios Medical Center Bad Abbach , Bad Abbach , Germany , and
| | - Wolfgang Hartung
- b Department of Rheumatology and Clinical Immunology , Asklepios Medical Center Bad Abbach , Bad Abbach , Germany , and
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Pereira J, Eugénio G, Calretas S, Santos R, Carvalho A. More Than Just a Case of Polymyalgia Rheumatica. Eur J Case Rep Intern Med 2016; 3:000374. [PMID: 30755863 PMCID: PMC6346904 DOI: 10.12890/2016_000374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2016] [Accepted: 01/17/2016] [Indexed: 11/05/2022] Open
Abstract
Malignant neoplasms are associated with a wide range of paraneoplastic rheumatological syndromes. These can be defined as remote effects of cancer, which are not caused by the tumor and its metastasis. The authors describe the case of an 82-year-old man, who presented with a one-month history of pain, stiffness, and functional limitation of the scapular and pelvic girdles. Blood tests showed raised levels of inflammatory markers. He was diagnosed with Polymyalgia Rheumatica, but the lack of response to corticosteroids led to the suspicion of an alternative diagnosis, like, for example, an occult neoplasm. Although patient evaluation was initially normal, five months later he developed macroscopic haematuria and was diagnosed with bladder and prostate carcinomas. After surgical treatment, the patient fully recovered from his rheumatological syndrome. LEARNING POINTS In cases when polymyalgia rheumatica exhibits atypical clinical features and/or therapeutic resistance, additional investigation is recommended.Paraneoplastic syndromes can lead to the diagnosis of an underlying neoplasm.
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Affiliation(s)
- João Pereira
- Department A of Internal Medicine, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Gisela Eugénio
- Department of Rheumatology, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Suzana Calretas
- Department A of Internal Medicine, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Rui Santos
- Department A of Internal Medicine, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Armando Carvalho
- Department A of Internal Medicine, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
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Emamifar A, Hess S, Gildberg-Mortensen R, Jensen Hansen IM. Association of Remitting Seronegative Symmetrical Synovitis with Pitting Edema, Polymyalgia Rheumatica, and Adenocarcinoma of the Prostate. AMERICAN JOURNAL OF CASE REPORTS 2016; 17:60-4. [PMID: 26839040 PMCID: PMC4745603 DOI: 10.12659/ajcr.895717] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Patient: Male, 83 Final Diagnosis: Remitting seronegative symmetrical synovitis with pitting edema Symptoms: Morning stiffness • pitting edema of the hands • shoulder and hip pain Medication: — Clinical Procedure: 18FDG PET/CT Specialty: Rheumatology
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Affiliation(s)
- Amir Emamifar
- Department of Rheumatology, University Hospital of Odense, Svendborg Hospital, Svendborg, Denmark
| | - Soeren Hess
- Department of Nuclear Medicine, Odense University Hospital, Odense, Denmark
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14
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Urologische Malignome und rheumatoide Arthritis. Z Rheumatol 2016; 75:54-62. [DOI: 10.1007/s00393-015-0031-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Zusammenfassung
Urologische Malignome sind relativ häufig und nehmen mit zunehmendem Lebensalter zu. Der demografische Wandel führt dazu, dass bei immer mehr Patienten mit entzündlich-rheumatischen Erkrankungen urogenitale Tumoren koinzident sind oder unter antirheumatischer Therapie auftreten. Die Basistherapie rheumatischer Erkrankungen muss in dieses Fällen individuell sorgfältig abgewogen werden, obwohl die begrenzte Evidenz für die meisten Situationen gegen eine massive Risikoerhöhung durch konventionelle und/oder biologische Basistherapeutika spricht. Paraneoplastische Phänomene auch im Bewegungsapparat können durch urogenitale Malignome ausgelöst werden. Mit den sich abzeichnenden Umwälzungen der medikamentösen Tumortherapie durch die Immunonkologie ergeben sich darüber hinaus neue Herausforderungen für die interdisziplinäre Kooperation von Uroonkologen und Rheumatologen. In dieser Übersichtsarbeit werden unter Berücksichtigung der aktuellen deutschen und europäischen Leitlinien die Diagnostik, Standardbehandlung und Nachsorge urologischer Malignome skizziert. Wir beschreiben Kernaspekte, die von Urologen und Rheumatologen beachtet werden sollten. Durch persönliche Absprache, regelmäßigen Erfahrungsaustausch und Einbeziehung von Rheumatologen in interdisziplinäre Tumorboards sollte zukünftig eine bessere Behandlung unserer gemeinsamen Patienten möglich werden.
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Abstract
For patients that present with musculoskeletal symptoms, diagnostic procedures carried out by physicians and rheumatologists are primarily aimed at confirming or excluding the occurrence of primary rheumatic diseases. Another important trigger for musculoskeletal disease, however, is the presence of a tumour. Careful clinical investigation and knowledge of the gestalt of musculoskeletal syndromes related to respective tumour entities is of utmost importance for the diagnosis of paraneoplastic rheumatic diseases such as hypertrophic osteoarthropathy, paraneoplastic polyarthritis, RS3PE syndrome, palmar fasciitis and polyarthritis, cancer-associated myositis and tumour-induced osteomalacia. This places great responsibility on rheumatologists in diagnosing malignancies and referring the patient for effective treatment. The selective influence of tumours on musculoskeletal tissue is surprising and indicates that tumours alter tissues such as the periosteum, synovial membrane, subcutaneous connective tissue, fascia, muscles and bones by specific molecular processes. Some of the underlying mechanisms have been unravelled, providing valuable information on the physiologic and pathophysiologic roles of mediators such as vascular endothelial growth factor and fibroblast growth factor 23.
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Affiliation(s)
- Bernhard Manger
- Department of Internal Medicine 3, University of Erlangen-Nuremberg, Ulmenweg 18, D-91054 Erlangen, Germany
| | - Georg Schett
- Department of Internal Medicine 3, University of Erlangen-Nuremberg, Ulmenweg 18, D-91054 Erlangen, Germany
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Whole-Body (18) FDG-PET in an Arthritis Paraneoplastic Syndrome Revealed an Underlying Hematological Neoplasm. Case Rep Med 2013; 2013:594704. [PMID: 23818905 PMCID: PMC3684035 DOI: 10.1155/2013/594704] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2013] [Revised: 04/27/2013] [Accepted: 05/19/2013] [Indexed: 11/18/2022] Open
Abstract
We showed the first image of 18FDG-PET, which leads to a diagnosis of lymphoma in an atypical polyarthritis. About 4% of patients with lymphoma or leukemia suffered from rheumatologic paraneoplastic symptoms like arthralgia and about 10% of the patients with rheumatologic or neurologic clinical symptoms develop a solid cancer or hematological neoplasm. 18FDG-PET is an interesting exam to identify an underlying malignancy when a paraneoplastic syndrome is suspected; it can detect the primitive lesion and/or the metastasis lesions. The use of the 18FDG-PET can help to detect earlier hematological neoplasm in cases of paraneoplastic syndrome without a determined cause and to treat more rapidly and specifically the patient.
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Baranowski A, Hansen M. [Bronchial carcinoma and knee pain. Secondary hypertrophic osteoarthropathy]. Unfallchirurg 2012; 116:744-8. [PMID: 23052705 DOI: 10.1007/s00113-012-2263-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Secondary hypertrophic osteoarthropathy (HOA), also known as Marie-Bamberger syndrome, is a rare neoplastic syndrome featuring clubbing of the tips of the digits, periosteal proliferation and synovial effusion of adjacent joints. We report a case where a patient without any other known medical condition developed persistent arthralgia and mobility restriction after bruising the left knee. As the initial X-ray examination of the knee showed a distinct periosteal proliferation of the left femoral bone, extended diagnostics were initiated during which a bronchial carcinoma was identified. After surgical removal of the primary tumor the symptoms of irritation in the knee joint recovered totally.
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Affiliation(s)
- A Baranowski
- Hochtaunus-Kliniken, Urseler Straße 33, Bad Homburg v.d.H, Germany.
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