Palmar fasciitis and polyarthritis syndrome associated with non-small-cell lung carcinoma

Abstract

A 56-year-old man presented with pain and stiffness in both shoulders and developed severe, rapidly progressive contractures of the fingers. Examination revealed subcutaneous thickening in both palms with fixed flexion deformities of all digits except the thumbs. Initial investigations including a malignancy screen were all normal/negative. Eighteen months later, he was diagnosed with metastatic non-small-cell lung carcinoma. Although rare, palmar fasciitis and polyarthritis syndrome is an important paraneoplastic syndrome for rheumatologists to be aware of, as the musculoskeletal symptoms may precede neoplastic manifestations by many months and may improve with appropriate treatment.

Palmar fasciitis and polyarthritis syndrome associated with transitional cell carcinoma of the bladder

“…The process can be at least halted by successful treatment of the malignancy, although the contractures and functional difficulties seem to persist. [13][14][15]17,21,24,28,37 Glucocorticoids and other drugs to modify the process have not been successful in previous cases or in this case.…”

“…* Bone scans, when reported, have (as in this case) shown uptake consistent with degenerative change. 37,38 But others have reported more definite inflammatory uptake, 4,30,31,34,39 demonstrating the variability in the degree of articular involvement in this condition. Inflammatory markers are typically not raised, and autoantibody screening is usually negative.…”

Report of anti-CCP antibody positive paraneoplastic polyarthritis and review of the literature

“…We performed a Medline literature search (1950-present) using the keywords paraneoplastic syndrome, rheumatoid arthritis, arthritis, paraneoplastic polyarthritis, malignancy and cancer to review all reported cases of paraneoplastic arthritis. Several case reports discuss this arthritis in association with various cancers (Table 1) [2][3][4][5][6][7][8][9][10][11]. It is also discussed in the literature how recognition of the polyarthritis and other paraneoplastic syndromes may assist in the early detection of some of these malignancies [12].…”

Indurated reticulate palmar erythema as a sign of paraneoplastic palmar fasciitis and polyarthritis syndrome

“…9 It is reported that if the ovarian carcinoma remits the PFPA symptoms abate, although contractures may remain. 13 The relentless course of the indurated palmar erythema in the presence of progressive polyarthritis was an indicator for a paraneoplastic presentation of PFPA in our patient and prompted oncological review.…”