1
|
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.
Collapse
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
| |
Collapse
|
2
|
Buchrits S, Kozlovoski D, Gafter-Gvili A, Raanani P, Hayman L, Revyako I, Bernstine H, Wolach O, Shimony S. Autoimmune and Inflammatory Manifestations Associated with Acute Myeloid Leukemia with Trisomy 8 - Case Series and Review of the Literature. Eur J Haematol 2021; 108:199-203. [PMID: 34748235 DOI: 10.1111/ejh.13725] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Accepted: 11/02/2021] [Indexed: 11/27/2022]
Abstract
AML can be associated with autoimmune or inflammatory phenomena (AIP) occurring prior, concomitantly or after its diagnosis. Trisomy 8 is one of the most common cytogenetic abnormalities associated with AML. We describe three patients with AML, trisomy 8 and associated AIP and review the known literature on this association. All of our patients had major symptomatic relief when treated with leukemia-directed therapy and corticosteroids. AIP in AML may be an underdiagnosed phenomenon, particularly in patients with trisomy 8.
Collapse
Affiliation(s)
- Shira Buchrits
- Internal Medicine Department A, Rabin Medical Center, Beilinson Hospital, Petah-Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel
| | - Dror Kozlovoski
- Internal Medicine Department A, Rabin Medical Center, Beilinson Hospital, Petah-Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel
| | - Anat Gafter-Gvili
- Internal Medicine Department A, Rabin Medical Center, Beilinson Hospital, Petah-Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel.,Institute of Haematology, Davidoff Cancer Center, Rabin Medical Center, Beilinson Hospital, Petah-Tikva, Israel
| | - Pia Raanani
- Sackler Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel.,Institute of Haematology, Davidoff Cancer Center, Rabin Medical Center, Beilinson Hospital, Petah-Tikva, Israel
| | - Lucille Hayman
- Pathology Department, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel
| | - Igor Revyako
- Pathology Department, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel
| | - Hanna Bernstine
- Sackler Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel.,Nuclear Medicine Department, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel
| | - Ofir Wolach
- Sackler Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel.,Institute of Haematology, Davidoff Cancer Center, Rabin Medical Center, Beilinson Hospital, Petah-Tikva, Israel
| | - Shai Shimony
- Sackler Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel.,Institute of Haematology, Davidoff Cancer Center, Rabin Medical Center, Beilinson Hospital, Petah-Tikva, Israel
| |
Collapse
|
3
|
Eickhoff JC, Collamer AN. Autoimmunity Mimics: Infection and Malignancy. Prim Care 2018; 45:343-360. [PMID: 29759128 DOI: 10.1016/j.pop.2018.02.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
Musculoskeletal rheumatic syndromes are commonly encountered in the primary care setting. A plethora of commonly encountered and rare infectious agents can produce osteoarticular and soft tissue manifestations. Likewise, malignancies may manifest rheumatic symptoms via direct tumor invasion or paraneoplastic effects. Awareness of these diseases and their clinical risk factors should result in improved screening and earlier recognition and intervention, leading to improved long-term outcomes and overall patient care.
Collapse
Affiliation(s)
- Jeffrey C Eickhoff
- Rheumatology Service, U.S. Navy, Medical Corps, Naval Medical Center Portsmouth, 620 John Paul Jones Circle, Portsmouth, VA 23708, USA.
| | - Angelique N Collamer
- Rheumatology Service, U.S. Air Force, Medical Corps, Walter Reed National Military Medical Center, Uniformed Services University, 4301 Jones Bridge Road, Bethesda, MD 20814-4799, USA
| |
Collapse
|
4
|
Characteristics of children with acute lymphoblastic leukemia presenting with arthropathy. Clin Rheumatol 2018; 37:2455-2463. [DOI: 10.1007/s10067-018-4034-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2017] [Revised: 02/08/2018] [Accepted: 02/12/2018] [Indexed: 10/18/2022]
|
5
|
Kumar B. Left-Sided Flank Pain, Fevers, and Fatigue in a 26-Year-Old Male With Seropositive Rheumatoid Arthritis. Arthritis Care Res (Hoboken) 2016; 68:1714-1720. [PMID: 26414970 DOI: 10.1002/acr.22735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2015] [Revised: 08/11/2015] [Accepted: 09/15/2015] [Indexed: 11/05/2022]
|
6
|
Morais SA, du Preez HE, Akhtar MR, Cross S, Isenberg DA. Musculoskeletal complications of haematological disease. Rheumatology (Oxford) 2015; 55:968-81. [DOI: 10.1093/rheumatology/kev360] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2015] [Indexed: 01/19/2023] Open
|
7
|
Abstract
BACKGROUND At disease onset, children with acute lymphoblastic leukaemia (ALL) may present with arthralgia or even signs of arthritis. This might cause misdiagnosis and thereby lead to prolonged diagnostic delay. The present study aimed to identify children with ALL with joint involvement and to compare their characteristics and outcome with children with ALL without joint involvement. METHODS Case records of 286 children diagnosed with ALL between 1992 and 2013 were reviewed and analysed in this retrospective, descriptive study. RESULTS Fifty-three (18.5%) children with ALL presented with localised joint pain, and half of them had objective signs of arthritis. The mean number of joints involved was 2.5, most frequently presenting as asymmetric oligoarthritis. The suspected misdiagnosis were reactive arthritis (19/53), osteomyelitis (9/53) and juvenile idiopathic arthritis (8/53). Children with joint involvement had less objective signs of haematological disease. Cytopenia was absent in 24% in children with joint involvement (vs 8% without, p=0.001), 50% had only one cell line affected (vs 21%, p=0.0005) and 44% had no organomegaly (vs 29%, p=0.05). Median diagnostic delay was 4 vs 2 weeks. The 5-year event-free and overall survival was superior for children with joint involvement: 94% vs 87% (p=0.049), and 96% vs 83% (p=0.044). CONCLUSIONS ALL with joint involvement is a frequent finding (18.5%). The clinical signs of leukaemia are less prominent, but non-articular pain should alert the clinician of a possible diagnosis of leukaemia. The overall and event-free survivals were superior compared with the children without joint involvement.
Collapse
Affiliation(s)
- Ninna Brix
- Department of Pediatrics, Aarhus University Hospital Skejby, Aarhus, Denmark
| | - Steen Rosthøj
- Department of Pediatrics, Aalborg University Hospital, Aalborg, Denmark
| | - Troels Herlin
- Department of Pediatrics, Aarhus University Hospital Skejby, Aarhus, Denmark
| | - Henrik Hasle
- Department of Pediatrics, Aarhus University Hospital Skejby, Aarhus, Denmark
| |
Collapse
|
8
|
Brazelton J, Louis P, Sullivan J, Peker D. Temporomandibular joint arthritis as an initial presentation of acute myeloid leukemia with myelodysplasia-related changes: a report of an unusual case. J Oral Maxillofac Surg 2014; 72:1677-83. [PMID: 24661537 DOI: 10.1016/j.joms.2014.02.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2013] [Revised: 01/27/2014] [Accepted: 02/01/2014] [Indexed: 12/11/2022]
Abstract
PURPOSE Patients with acute myeloid leukemia (AML) often present with fatigue and severe pancytopenia. We report the case of a 68-year-old woman with no significant medical history who presented with 1 year of progressively worsening bilateral temporomandibular joint (TMJ) pain. She was otherwise asymptomatic. A computed tomography scan revealed degenerative joint disease in both TMJs. Bilateral TMJ replacement was performed. MATERIALS AND METHODS The excised TMJ tissue underwent formalin fixation and decalcification, and routine hematoxylin and eosin-stained sections were generated. RESULTS Immunohistochemical stains showed a population of monotonous cells in the marrow space expressing CD33, CD43, and myeloperoxidase, confirming the diagnosis of myeloid neoplasm. Subsequent bone marrow biopsy with flow cytometry confirmed AML with myelodysplasia-related changes. CONCLUSIONS Adult patients with AML can rarely present with musculoskeletal complaints alone, which could delay the diagnosis. To our knowledge, this is the first report of AML with myelodysplasia-related changes presenting in a patient with TMJ degenerative joint disease that was otherwise asymptomatic.
Collapse
Affiliation(s)
- Jason Brazelton
- Resident, Department of Pathology, University of Alabama at Birmingham, Birmingham, AL
| | - Patrick Louis
- Professor, Department of Oral and Maxillofacial Surgery, University of Alabama at Birmingham, Birmingham, AL
| | - Joseph Sullivan
- Associate Professor, Department of Radiology, University of Alabama at Birmingham, Birmingham, AL
| | - Deniz Peker
- Assistant Professor, Department of Pathology, University of Alabama at Birmingham, Birmingham, AL.
| |
Collapse
|
9
|
Kisacik B, Onat AM, Kasifoglu T, Pehlivan Y, Pamuk ON, Dalkilic E, Donmez S, Bilge SY, Yilmaz S, Erdem H, Mercan R, Ozturk MA, Bes C, Soy M, Erten S, Cobankara V, Senel S, Oner FA, Direskeneli H, Yilmaz S, Yazici A, Emmungil H, Aksu K, Kul S, Cetin GY, Sayarlioglu M. Diagnostic dilemma of paraneoplastic arthritis: case series. Int J Rheum Dis 2014; 17:640-5. [PMID: 24433553 DOI: 10.1111/1756-185x.12277] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Paraneoplastic arthritis (PA) may mimic rheumatic diseases. While presenting the demographic and laboratory features of the patients diagnosed with PA, this study also aims to provide possible appropriate tools to differentiate the PA cases from early rheumatoid arthritis (ERA). METHODS Sixty-five patients with PA (male/female: 43/22) from 15 different rheumatology clinics and 50 consecutive patients with ERA (male/female: 13/37) fulfilling the 2010 American College of Rheumatology (ACR) criteria for the diagnosis if the RA from Gaziantep Rheumatology Early Arthritis Trial (GREAT) as controls who were diagnosed at least 12 months before, were enrolled into study. RESULTS Mean ages of the patients with PA and ERA were 50.2 ± 15.3, and 42.7 ± 12.3, respectively, and the mean ages of the patients with PA were significantly higher than the ERA. Unlike the ERA patients, in our case series PA was predominantly observed among males. Oligoarthritis was significantly higher in solid tumors in contrast to ERA (P = 0.001). Polyarthritis and symmetric arthritis were significantly higher in the ERA group in contrast to all malignancies (P = 0.001). Rheumatoid factor (RF) and anticyclic citrullinated peptide antibody (anti-CCP) positivity were significantly higher in the ERA group (each P = 0.001). Lactic dehydrogenase levels of hematologic malignancies were significantly higher than other groups (each, P = 0.001). CONCLUSIONS ERA patients had more symmetric joint involvement than PA; laboratory markers could be also an alternative where there is high RF and anti-CCP positivity with antibody levels among the ERA patients. Finally, the demographic features can be used as differentiating factors; ERA was seen predominantly among females aged 40-59 years which refers to young adults.
Collapse
Affiliation(s)
- Bunyamin Kisacik
- Department of Internal Medicine, Division of Rheumatology, Gaziantep University Faculty of Medicine, Gaziantep, Turkey
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
10
|
Kim KJ, Kwok SK, Park YJ, Kim WU, Cho CS. Low C3 levels is associated with neutropenia in a proportion of patients with myelodysplastic syndrome: retrospective analysis. Int J Rheum Dis 2012; 15:86-94. [DOI: 10.1111/j.1756-185x.2012.01704.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Ki-Jo Kim
- Division of Rheumatology; Department of Internal Medicine; College of Medicine; Catholic University of Korea; Seoul; Korea
| | - Seung-Ki Kwok
- Division of Rheumatology; Department of Internal Medicine; College of Medicine; Catholic University of Korea; Seoul; Korea
| | - Yun-Jung Park
- Division of Rheumatology; Department of Internal Medicine; College of Medicine; Catholic University of Korea; Seoul; Korea
| | - Wan-Uk Kim
- Division of Rheumatology; Department of Internal Medicine; College of Medicine; Catholic University of Korea; Seoul; Korea
| | - Chul-Soo Cho
- Division of Rheumatology; Department of Internal Medicine; College of Medicine; Catholic University of Korea; Seoul; Korea
| |
Collapse
|
11
|
Paraneoplastic rheumatic syndromes: report of eight cases and review of literature. Rheumatol Int 2011; 32:1485-9. [PMID: 22090010 DOI: 10.1007/s00296-011-2252-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2011] [Accepted: 10/22/2011] [Indexed: 12/19/2022]
Abstract
Malignant neoplasms are associated with a wide variety of paraneoplastic rheumatological syndromes. The paraneoplastic nature should be based on specific criteria. We report a series of eight cases of paraneoplastic rheumatic syndromes revealing an underlying neoplasia. Our series consists of six men and two women, with a mean age of 46.1 (20-69 years). The first case is a hypertrophic osteoarthropathy of Pierre Marie that occurred in a 20-year-old man 1 month after treatment for his nasopharyngeal carcinoma; the paraclinical examinations showed lung and bone metastasis. The second case is that of a bilateral shoulder-hand syndrome revealing an invasive squamous cell carcinoma of the cervix in a 63-year-old woman. The third case involved a 69-year-old patient who had surgery 2 years ago for prostate adenocarcinoma and presented with polymyalgia rheumatica revealing bone metastasis. We also report two cases of leukemia in adults revealed by polyarthritis. The sixth observation is that of a paraneoplastic scleroderma that occurred concomitantly with prostate cancer. The seventh case of an acute arthritis showed a B lymphoma. The eighth case is that of a 52-year-old patient who presented with inflammatory arthralgias, and digital clubbing revealing a squamous cell carcinoma of the skin. Paraneoplastic rheumatism remains a rare event, but knowledge of it is essential for early diagnosis of underlying cancer.
Collapse
|
12
|
Reuss-Borst M. [Hemato-oncological diseases. Associated rheumatic symptoms]. Z Rheumatol 2011; 70:561-6. [PMID: 21858487 DOI: 10.1007/s00393-011-0816-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Paraneoplastic syndromes are observed in up to 8% of tumor patients. These disorders arise from tumor secretion of hormones, peptides, growth factors or cytokines or from immune cross-reactivity between malignant and normal tissues. Among many others paraneoplastic syndromes may also affect the rheumatologic system resulting in various musculoskeletal symptoms and/or syndromes. On the other hand, mainly hematological or lymphoproliferative diseases may also cause rheumatic symptoms by cell invasion or when affecting cellular elements of blood or the coagulation system. The aim of this article is to provide an overview of the various associations between rheumatic symptoms and hemato-oncological diseases which might be of importance in clinical practice.
Collapse
Affiliation(s)
- M Reuss-Borst
- Fachklinik für Rheumatologie und Onkologie, Klinik Am Kurpark, Kurhausstrasse 9, Bad Kissingen,Germany.
| |
Collapse
|
13
|
Esen BA, Özer L, Kamalı S, İnanç M. A Prodrome of Acute Lymphoblastic
Leukemia Mimicking Sacroiliitis. ELECTRONIC JOURNAL OF GENERAL MEDICINE 2011. [DOI: 10.29333/ejgm/82718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
|
14
|
Acree SC, Pullarkat ST, Quismorio FP, Mian SR, Brynes RK. Adult Leukemic Synovitis Is Associated With Leukemia of Monocytic Differentiation. J Clin Rheumatol 2011; 17:130-4. [DOI: 10.1097/rhu.0b013e318214befe] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
15
|
Rugienė R, Dadonienė J, Aleknavičius E, Tikuišis R, Distler J, Schett G, Venalis P, Venalis A. Prevalence of paraneoplastic rheumatic syndromes and their antibody profile among patients with solid tumours. Clin Rheumatol 2011; 30:373-80. [PMID: 21225302 DOI: 10.1007/s10067-010-1676-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2010] [Accepted: 12/22/2010] [Indexed: 12/19/2022]
Abstract
The aims of this study were to assess the prevalence of paraneoplastic rheumatic syndromes in a cohort of patients with newly diagnosed solid tumours and to describe their autoimmune profile, comparing it to the controls. Screening questionnaires (3,770) were distributed, and during a three-step study, 94 patients were confirmed to have both paraneoplastic syndrome and oncology diagnoses. Three control groups-patients with undifferentiated arthritis, Raynaud's phenomenon for non-malignant causes and solid tumours only-were designed to compare with the paraneoplastic cases and their immunology profile. The prevalence of paraneoplastic rheumatic syndromes was 2.65% (95% CI 0.21-3.20). The group of patients with arthritis and the group of patients with Raynaud's syndrome were found to prevail among other clinical presentations of paraneoplastic rheumatic syndromes. Both paraneoplastic syndromes were linked to malignancies of the urogenital system. Antinuclear antibodies were found to be similarly frequent in the paraneoplastic arthritis, paraneoplastic Raynaud's phenomenon and the solid tumour groups. No differences were observed when comparing paraneoplastic arthritis and undifferentiated arthritis, except that the patients with paraneoplastic arthritis were older. Comparing paraneoplastic Raynaud's to Raynaud's phenomenon, male preponderance in the paraneoplastic Raynaud's phenomenon group was observed, and the patients were obviously older. Paraneoplastic rheumatic syndromes are rare and more often occur in older patients. Among them, paraneoplastic arthritis and Raynaud's syndrome were the most frequent. The immunology profile does not help in discriminating between arthritis and paraneoplastic arthritis patients and is of limited use in Raynaud's differential diagnosis.
Collapse
Affiliation(s)
- Rita Rugienė
- State Research Institute Centre for Innovative Medicine, Zygimantu 9, Vilnius, Lithuania.
| | | | | | | | | | | | | | | |
Collapse
|
16
|
Yinh J, Pilichowska M, Kalish R. A 27-year-old Cambodian woman with fever, lymphadenopathy, and arthritis. Arthritis Care Res (Hoboken) 2010; 62:1194-9. [PMID: 20506551 DOI: 10.1002/acr.20224] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Janeth Yinh
- Tufts Medical Center, Boston, Massachusetts 02111, USA.
| | | | | |
Collapse
|
17
|
Affiliation(s)
- M Al Muslahi
- Department of Clinical Haematology and Bone Marrow Transplantation, Royal Adelaide Hospital and Division of Haematology, Institute of Medical and Veterinary Science Adelaide, South Australia, Australia
| | | |
Collapse
|
18
|
Affiliation(s)
- Abraham B Schwarzberg
- Harvard Medical School, Department of Medicine, Massachusetts General Hospital, Boston, MA 02114, USA.
| | | | | | | |
Collapse
|
19
|
Affiliation(s)
- M Ehrenfeld
- Department of Medicine C, Sheba Medical Center, Tel-Hashomer, Israel
| | | |
Collapse
|
20
|
El aichaoui S, Bahiri R, Benbouazza K, Bzami F, Amine B, Allali F, Hajjaj-Hassouni N. [Leukemia revealed by polyarthritis]. Rev Med Interne 2006; 27:555-7. [PMID: 16750282 DOI: 10.1016/j.revmed.2006.04.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2005] [Accepted: 04/03/2006] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Ostéoarticular manifestation whose reveal leukaemia in 4% of the cases, regress completely with haematological remission. EXEGESIS We report two observations of leukaemia revealed by polyarthritis. A 22-year-old woman has presented a polyarthritis 8 months before de diagnosis of acute leukaemia. A 34 years old men, has presented one month before admission an acute polyarthritis revealing chronic myeloid leukaemia. CONCLUSION Polyarthritis may reveal an acute or chronic leukaemia. Systematic blood analysis can make a difference in diagnosis of recent polyarthritis.
Collapse
Affiliation(s)
- S El aichaoui
- Service de Rhumatologie B, CHU de Rabat-Sale, Hôpital El-Ayachi, Salé, Maroc
| | | | | | | | | | | | | |
Collapse
|
21
|
Fukushima K, Matsuda M, Mitsuhashi S, Gono T, Kaneko K, Nakazawa H, Ito T, Ikeda SI. Migrating osteoarthralgia: a rare initial manifestation of adult leukemia. Intern Med 2006; 45:175-6. [PMID: 16508235 DOI: 10.2169/internalmedicine.45.1561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Kazuhiro Fukushima
- Third Department of Medicine, Shinshu University School of Medicine, Matsumoto
| | | | | | | | | | | | | | | |
Collapse
|
22
|
Kim HR, Hong JH, Yoon CH, Lee SH, Park SH, Kim HY. Arthritis preceding acute biphenotypic leukemia. Clin Rheumatol 2005; 25:380-1. [PMID: 16220224 DOI: 10.1007/s10067-005-0025-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2005] [Accepted: 03/10/2005] [Indexed: 11/26/2022]
Affiliation(s)
- H R Kim
- Department of Internal Medicine, Division of Rheumatology, Kangnam St., Mary's Hospital, College of Medicine, The Catholic University of Korea, 505 Banpo-dong Seocho-ku, Seoul, 137-040, South Korea
| | | | | | | | | | | |
Collapse
|
23
|
Hammoudeh M. Acute lymphocytic leukemia presenting as lupus-like syndrome. Rheumatol Int 2005; 26:581-2. [PMID: 16136312 DOI: 10.1007/s00296-005-0017-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2004] [Accepted: 05/25/2005] [Indexed: 10/25/2022]
Abstract
Lupus-like syndrome has been described in association with various malignancies. Acute lymphocytic leukemia presenting as lupus-like syndrome has been reported in children. We report a 22-year-old male patient who developed joint and muscle ache, pleurisy, leukopenia, thrombocytopenia, fever, weight loss and was found to have positive antinuclear antibodies. Repeated peripheral smear twice did not show any abnormal cells. Six months later, bone marrow biopsy showed acute lymphocytic leukemia.
Collapse
Affiliation(s)
- Mohammed Hammoudeh
- Rheumatology Section, Department of Medicine, Hamad General Corporation, P. O. Box 3050, Doha, Qatar.
| |
Collapse
|
24
|
Sandberg Y, El Abdouni M, Lam KH, Langerak AW, Lugtenburg PJ, Dolhain RJEM, Heule F. Clonal identity between skin and synovial tissue in a case of mycosis fungoides with polyarthritis. J Am Acad Dermatol 2005; 51:111-7. [PMID: 15243535 DOI: 10.1016/j.jaad.2004.01.043] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Polyarthritis in the presence of a cutaneous T-cell lymphoma is a rare phenomenon. We describe a case of mycosis fungoides with development of a symmetric erosive polyarthritis of the small hand joints and feet, diagnosed as rheumatoid arthritis. An identical monoclonal T-cell population in the skin and in the synovium was detected by T-cell receptor gene rearrangement analysis, illustrating articular dissemination of lymphoma cells. Differentiating mycosis fungoides-associated arthritis from rheumatoid arthritis may have important implications for treatment. Based on this case, the relevant literature, and the newest disease concepts, pathogenic mechanisms and therapeutic options of mycosis fungoides-associated arthritis are discussed.
Collapse
Affiliation(s)
- Yorick Sandberg
- Department of Immunology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | | | | | | | | | | | | |
Collapse
|
25
|
Amine B, Benbouazza K, Allali F, Faik A, Maaroufi H, El Hassani S, Hajjaj-Hassouni N. Chronic polyarthritis as the presenting manifestation of acute leukemia. Joint Bone Spine 2005; 72:189-91. [PMID: 15797505 DOI: 10.1016/j.jbspin.2004.09.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2003] [Accepted: 09/29/2004] [Indexed: 10/26/2022]
|
26
|
Bassan R, Gatta G, Tondini C, Willemze R. Adult acute lymphoblastic leukaemia. Crit Rev Oncol Hematol 2005; 50:223-61. [PMID: 15182827 DOI: 10.1016/j.critrevonc.2003.11.003] [Citation(s) in RCA: 66] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/18/2003] [Indexed: 11/22/2022] Open
Abstract
Acute lymphoblastic leukaemia (ALL) in adults is a relatively rare neoplasm with a curability rate around 30% at 5 years. This consideration makes it imperative to dissect further the biological mechanisms of disease, in order to selectively implement an hitherto unsatisfactory success rate. The recognition of discrete ALL subtypes (some of which deserve specific therapeutic approaches, like T-lineage ALL (T-ALL) and mature B-lineage ALL (B-ALL)) is possible through an accurate combination of cytomorphology, immunophenotytpe and cytogenetic assays and has been a major result of clinical research studies conducted over the past 20 years. Two-three major prognostic groups are now easily identifiable, with a survival probability ranging from <10 to 20% (Philadelphia-positive ALL) to about 50-60% (low-risk T-ALL and selected patients with B-lineage ALL). These issues are extensively reviewed and form the basis of current knowledge. The second major point relates to the emerging importance of studies that reveal a dysregulated gene activity and its clinical counterpart. It is now clear that prognostication is a complex matter ranging from patient-related issues to cytogenetics to molecular biology, including the evaluation of minimal residual disease (MRD) and possibly gene array tests. On these bases, the role of a correct, highly personalised therapeutic choice will soon become fundamental. Therapeutic progress may be obtainable through a careful integration of chemotherapy, stem cell transplantation, and the new targeted treatments with highly specific metabolic inhibitors and humanised monoclonal antibodies.
Collapse
|
27
|
Güven GS, Ozçakar L, Koçak T, Aksu S. Knee arthritis as a rare inaugural manifestation of adult leukemia. Rheumatol Int 2004; 25:317-8. [PMID: 15889306 DOI: 10.1007/s00296-004-0491-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2004] [Accepted: 05/23/2004] [Indexed: 11/28/2022]
|
28
|
Chakravarty EF, Genovese MC. Associations between rheumatoid arthritis and malignancy. Rheum Dis Clin North Am 2004; 30:271-84, vi. [PMID: 15172040 DOI: 10.1016/j.rdc.2004.01.007] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
There are many complex associations between rheumatoid arthritis(RA) and malignancy. Patients with rheumatic diseases on the whole appear to be at increased risk for the development of certain malignancies. The data from several studies are persuasive that the presence of RA conveys an increased risk for the development of lymphoproliferative disorders and may convey a decreased risk for the development of malignancies of the digestive tract. Understanding the complex interrelationships between RA and malignancy will lead to more accurate diagnosis of underlying pathology, more effective treatment of symptoms and underlying disease, and appropriate surveillance for the development of later complications.
Collapse
Affiliation(s)
- Eliza F Chakravarty
- Division of Immunology and Rheumatology, Stanford University School of Medicine, 1000 Welch Road, #203, Palo Alto, CA 94303, USA
| | | |
Collapse
|
29
|
Birlik M, Akar S, Onen F, Ozcan MA, Bacakoglu A, Ozkal S, Manisali M, Akkoc N. Articular, B-cell, non-Hodgkin's lymphoma mimicking rheumatoid arthritis: synovial involvement in a small hand joint. Rheumatol Int 2003; 24:169-72. [PMID: 14658004 DOI: 10.1007/s00296-003-0373-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2003] [Accepted: 06/24/2003] [Indexed: 12/01/2022]
Abstract
Polyarticular joint manifestations as the predominant symptom of non-Hodgkin's lymphoma (NHL) are quite rare. In the absence of peripheral lymph node and visceral involvement, lymphomas presenting as polyarthritis create a problem for the patients as another rheumatic disease. We present a case that had been diagnosed with rheumatoid arthritis because of symmetrical articular symptoms. The patient later developed severe pain and marked swelling in her right fourth finger, and a diagnosis of septic arthritis and osteomyelitis complicating rheumatoid arthritis was assumed. The final diagnosis of NHL with synovial involvement could be made only after histopathologic examination of a biopsy specimen obtained from the amputated finger. This is the first case report demonstrating direct synovial involvement of a small joint in a patient with NHL presenting with polyarthritis. Articular and periarticular involvement of multiple joints shown by MRI in this patient suggests that direct synovial involvement may be responsible for the polyarticular symptoms in such patients.
Collapse
Affiliation(s)
- Merih Birlik
- Division of Immunology-Rheumatology, Department of Internal Medicine, Dokuz Eylul University School of Medicine, Izmir, Turkey.
| | | | | | | | | | | | | | | |
Collapse
|
30
|
Abstract
The relation between rheumatic syndromes and an underlying malignancy is a complex one. As a result of autoimmunity, an aberrant immune response, or the use of immunomodulatory drugs, many of the rheumatic diseases appear to pose an increased risk for the development of malignancy. Unfortunately, for many of the same reasons, the presence of an underlying malignancy can result in the development of features of rheumatic disease. Awareness of the associations between rheumatic syndromes and malignancy will aid the clinician in the accurate diagnosis of underlying pathology, more effective treatment of both the symptoms and underlying disease, and appropriate surveillance for the development of later complications.
Collapse
|
31
|
Kebriaei P, Anastasi J, Larson RA. Acute lymphoblastic leukaemia: diagnosis and classification. Best Pract Res Clin Haematol 2002; 15:597-621. [PMID: 12617866 DOI: 10.1053/beha.2002.0224] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Acute lymphoblastic leukaemia (ALL) is a heterogeneous disease with distinct biological and prognostic groupings. Diagnosis relies on traditional cytomorphological and immunohistochemical evaluation of the leukaemic blasts. Subsequently, cytogenetic analysis identifies clonal numeric and/or structural chromosomal abnormalities that may be present, thus confirming the subtype classification and providing important prognostic information for treatment planning. The major chromosomal abnormalities in ALL are t(9;22)(q34;q11), t(12;21)(p13;q22), t(4;11)(q21;q23), t(1;19)(q23;p13), 8q24 translocations and hyperdiploidy. Generally, hyperdiploidy, occurring most frequently in paediatric cases, is associated with a good prognosis, while hypodiploidy confers a poor prognosis. Among structural chromosomal abnormalities, the t(9;22)(q34;q11) resulting in the BCR/ABL fusion protein, and rearrangements of the MLL gene, confer a poor prognosis in both children and adults, while t(12;21)(p13;q22), resulting in the TEL/AML1 fusion protein, and del (12p) confer a good prognosis. More recently, additional diagnostic and prognostic information has been gained from fluorescence in situ hybridization (FISH) and DNA microarray techniques.
Collapse
Affiliation(s)
- Partow Kebriaei
- Section of Hematology/Oncology, Department of Medicine and Cancer Research Center, University of Chicago, Chicago, Illinois 60637, USA
| | | | | |
Collapse
|
32
|
Abstract
Rheumatic disorders associated with cancer include a variety of conditions, most of which have no features distinguishing them from idiopathic rheumatic disorders. It is generally held that an extensive search for occult malignancy in most rheumatic syndromes is not recommended unless the case is accompanied by specific findings suggestive of malignancy. Within the past year information has accumulated on the role of long-standing rheumatic disorders as premalignant conditions and the role of autoantibodies as screening tests for occult cancer. The present article discusses cancer-associated rheumatic syndromes, calls attention to aspects that may suggest the presence of a hidden cancer, and examines the role of laboratory tests as clues of a possible neoplastic etiology of those syndromes.
Collapse
Affiliation(s)
- J E Naschitz
- Department of Internal Medicine A, Bnai Zion Medical Center, Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.
| |
Collapse
|
33
|
|