Musculoskeletal manifestations in patients with malignant disease

Abstract

To detect and describe the incidence of musculoskeletal manifestations in different malignant diseases as well as their relation to the treatment received whether by chemotherapy or radiation therapy. Sixty patients with different malignant diseases were included in this study, 45 with solid tumors and 15 patients with hematological malignancy. The mean age was 46.55 +/- 11.04 years and the mean disease duration was 2 +/- 0.75 years. The patients were fully examined for any rheumatologic involvement, laboratory investigations were performed as well as dual energy X-ray absorptiometry study for bone densitometry. Treatment strategies were assessed including the chemotherapeutics, radiation therapy, and/or surgery. Myalgias and arthralgias were the most frequent followed by flexor tenosynovitis, frozen shoulder, and fibromyalgia syndrome. Hypertrophic osteoarthropathy was seen in five patients, cutaneous vasculitis in two patients as well as arthritis. Osteonecrosis was present in one of the lunate carpal bones of a patient with non-Hodgkin's lymphoma (1.67%) and receiving high dose steroids. Rheumatoid factor was positive in four patients, three of which had hepatitis C virus positivity and cryoglobulins. Anti-neutrophil cytoplasmic antibody was negative in all the studied patients. The bone mineral density was significantly reduced in the patients with malignancy compared to the control. Mild to moderate osteoporosis was present, being more evident in the spine and forearm. The bone loss was higher in those with solid tumors and even more obvious in those receiving aromatase inhibitors. Musculoskeletal manifestations occurring during malignancies and following the treatment represent a significant percentage of symptoms and signs which may raise a clue to differential diagnosis.

Frozen shoulder and risk of cancer: a population-based cohort study

“…On the basis of 60 patients, Gheita et al (2010) reported that musculoskeletal lesions can follow a cancer diagnosis with frozen shoulder occurring in 20% of patients with solid cancers and 7% of patients with haematological cancers within a mean follow-up time of 3 years. Wedgwood and Benson (1992) observed seven cases (8%) of frozen shoulder within 30 days after surgery among 89 patients with modified radical mastectomy.…”

“…Frozen shoulder can be a musculoskeletal manifesting of solid tumours and haematological malignancies (Ashour et al , 1997; Latham et al , 2001; Singh et al , 2005; Gheita et al , 2010), and may also represent a misdiagnosed shoulder tumour (Demaziere and Wiley, 1991; Robinson et al , 2003; Sano et al , 2010). In addition, frozen shoulder is a frequent complication after mastectomy due to breast cancer (Wedgwood and Benson, 1992; Cheville and Tchou, 2007).…”

Issues associated with Aromatase Inhibitor–Associated Musculoskeletal Symptoms in Breast Cancer

“…In objective measurement, some studies check the cytokine level as IL-1,IL-6, IL-8,IL -10,IL -12,IL -17; IFN-β; TNF-ά compared to the degree of inflammation [24] or the estradiol change because estrogen is associated with chondroprotective effects through decreasing collagen degradation [12] . Bone mineral density may also serve as a target in monitoring AIMSS, such as in a IBIS-II bone sub-study [25,26] where Kyvernitakis et al examined the effects of AI on the serum levels of sclerostin, dickkopf-1 (DKK-1) and osteoprotegerin (OPG), as markers of bone turnover and bone mineral density, concluding sclerostin levels are an indication of the central role of osteocytes in bone turnover in women with breast cancer [27] . Thus far, no definite marker has been identified as an indicator of AIMSS.…”

Epidemiology and awareness of osteoporosis: a viewpoint from the Middle East and North Africa

“…The prevalence of OP is higher in Parkinson's disease and multiple sclerosis patients and seems related to reduced mental, physical performance and drug therapy [109,110]. Gheita et al [81,111] reported that BMD was notably lower in patients with different malignancies. Moreover, the severity of tumor significantly correlated with the hip and spine DXA.…”

“…Bone loss and high rate of fractures occur early after the initiation of corticosteroids, even with inhaled steroid, and are related to dosage and therapy duration [49,79]. Cancer therapy induced OP and increased risk of fragility fracture and mortality were reported [80,81]. Chemotherapy-induced OP occurred in 25.8% of cancer survivors in Saudi Arabia [82].…”