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

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.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

Sensing acidosis: nociception or sngception?

“…Besides, TRPV1 and TDAG8 are involved in RA-associated inflammation and RA-induced hyperalgesia in animal models [ 40 ]. Unfortunately, we know little about whether soreness is also a prominent phenotype in RA patients, although muscle soreness is reported in 24% of patients with paraneoplastic rheumatic syndromes [ 41 ]. In the majority of cases, sngception is commonly overwhelmed by co-existing nociception and thus becomes relatively less distinct.…”

Paraneoplastic demyelinating polyneuropathy associated with cardiac myxoma

“…Our patient had laboratory evidence of rheumatoid arthritis and a few constitutional signs of myxoma such as an elevated ESR and thrombocytopenia. The systemic manifestations in patients with autoimmune disease might trigger paraneoplastic autoimmunity, but we could not verify this hypothesis.…”

A case of rash and arthralgias

“…4 Malignancy associated with LCV occurs in less than 5% of cases; 5,6 but appropriate age-related investigations for malignancy should be considered, especially when LCV remains refractory to first-line treatments. 7…”