Diagnostic dilemma of paraneoplastic arthritis: case series

Kısacık, Bünyamin; Onat, Ahmet Mesut; Kaşifoğlu, Timuçin; Pehlıvan, Yavuz; Pamuk, Ömer Nurı; Dalkılıç, Ediz; Dönmez, Salim; Bilge, Şuheyb; Yılmaz, Sedat; Erdem, Hakan; Mercan, Rıdvan; Öztürk, Mehmet Akif; Beş, Cemal; Soy, Mehmet; Erten, Şükran; Çobankara, Veli; Şenel, Soner; Öner, Fatma Alıbaz; Direşkeneli, Haner; Yılmaz, Sema Dereli; Yazıcı, Ayten; Emmüngil, Hakan; Aksu, Kenan; Kül, Seval; Çetin, Gözde Yıldırım; Sayarlıoğlu, Mehmet

doi:10.1111/1756-185x.12277

Cited by 42 publications

(43 citation statements)

References 16 publications

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“… 19 , were also observed in this study, including the absence of deformities, rheumatoid nodules, and previous family history of rheumatoid arthritis. Similar to current research showing that RF is increased in 23–42% of patients with malignancy 17 , 20 , 43% of patients with malignancy tested positive for RF in our study. Additionally, two patients were positive for anti-CCP antibodies.…”

Section: Discussionsupporting

confidence: 92%

“…As anti-CCP has been reported to have a high specificity (90–96%) for RA 21 , 22 , this may demonstrate that using positive results of RF and anti-CCP antibody to distinguish between paraneoplastic rheumatic syndromes and RA are not always reliable. Nonetheless, higher titers of RF and anti-CCP were mostly found in early-onset RA patients 20 .…”

Section: Discussionmentioning

confidence: 96%

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Malignancy dominated with rheumatic manifestations: A retrospective single-center analysis

Wen

Ouyang

Yang

et al. 2018

Sci Rep

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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.Paraneoplastic syndromes involve symptoms mediated by hormones and cytokines from a tumor or are the consequence of humoral or cellular immune mechanisms directed against tumor cells, though direct invasion by the tumor or metastases does not occur. Several studies have indicated connections between malignancy and rheumatic manifestations [1][2][3] . In the case of paraneoplastic rheumatic syndromes, rheumatic symptoms can coincide, precede, or follow the diagnosis of cancer or herald its recurrence 4

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Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 96%

Malignancy dominated with rheumatic manifestations: A retrospective single-center analysis

Wen

Ouyang

Yang

et al. 2018

Sci Rep

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“…EORA may present with atypical manifestations, such as weight loss, myalgia, lymphadenopathy, polymyalgia rheumatica (PMR)‐like syndrome and neuropathy . Differential diagnoses of EORA include crystal arthritis, PMR, paraneoplastic arthritis and endocrinopathies . Optimal treatment of EORA is guided by clinical experience and cohort studies rather than randomized controlled clinical trials, because the elderly with significant co‐morbidities are often excluded from these investigations .…”

Section: Introductionmentioning

confidence: 99%

Comparison of elderly- and young-onset rheumatoid arthritis in an Asian cohort

et al. 2016

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“…The case series by Kisacik et al . in this issue is a reminder of this phenomenon, whereby the paraneoplastic syndrome presents no more than 2 years before the diagnosis of cancer. The authors compared paraneoplastic arthritis (PA) with early rheumatoid arthritis (ERA), two clinically challenging conditions with masquerading common features.…”

mentioning

confidence: 94%

“…Symmetrical small joint polyarthritis occurring after the age of 45 years, with high inflammatory markers in the absence of RF and CCP antibodies has been proposed as a red flag for PA, but the differential is broad for this scenario, and rarely is it malignancy based. Elevated lactic dehydrogenase (LDH) levels warrant investigation as a clue to hematological malignancy in adults and children …”

mentioning

confidence: 99%