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Zhao M, Mi L, Ji Y, He X, Gao Y, Hu Y, Xu K. Advances of autoimmune rheumatic diseases related to malignant tumors. Inflamm Res 2023; 72:1965-1979. [PMID: 37768354 PMCID: PMC10611618 DOI: 10.1007/s00011-023-01780-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Revised: 07/30/2023] [Accepted: 08/04/2023] [Indexed: 09/29/2023] Open
Abstract
BACKGROUND Malignant neoplasms are a well-recognized global public health concern, with significant impacts on human health and quality of life. The interplay between tumors and autoimmune rheumatic diseases is complex, and the resulting tumor-associated rheumatic diseases represent a rare and intricate group of conditions that occur in the context of malignant tumors. In addition, various rheumatic diseases can arise as a consequence of oncology treatment. These diseases present with intricate clinical manifestations and pathological features, often rendering them challenging to diagnose and impacting patients' quality of life. Despite this, they have yet to be fully recognized. METHODS This article presents a literature review of published original articles and review articles concerning paraneoplastic rheumatic syndromes and rheumatic diseases associated with cancer treatment. We conducted a comprehensive literature search in PubMed, Web of Science and Google Scholar databases, excluding duplicated and irrelevant studies. In cases of duplicated research, we selected articles with higher impact factors for the review. RESULTS This review focuses on the clinical features, diagnosis, and treatment of paraneoplastic rheumatic diseases, as well as the pathogenesis of these diseases. Additionally, we summarize the autoimmune rheumatic diseases associated with cancer treatment. Ultimately, the goal of this review is to enhance recognition and improve the management of autoimmune rheumatic diseases related to tumors.
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Affiliation(s)
- Miaomiao Zhao
- Third Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Taiyuan, 030032, China
| | - Liangyu Mi
- Third Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Taiyuan, 030032, China
| | - Yuli Ji
- Third Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Taiyuan, 030032, China
| | - Xiaoyao He
- Department of Statistics, School of Public Health, Shanxi Medical University, Taiyuan, China
| | - Yanan Gao
- Third Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Taiyuan, 030032, China
| | - Yuting Hu
- Third Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Taiyuan, 030032, China
| | - Ke Xu
- Third Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Taiyuan, 030032, China.
- Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, Taiyuan, 030032, China.
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Ung N, Gunasingam C, Cai K, Manolios N, Bayly A, Dinh P, Orr Y, Choudhary P, Wong P. Cardiac sarcoma presenting as paraneoplastic arthritis and clubbing: a case report and literature review. BMC Rheumatol 2023; 7:30. [PMID: 37715284 PMCID: PMC10503070 DOI: 10.1186/s41927-023-00350-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 07/31/2023] [Indexed: 09/17/2023] Open
Abstract
BACKGROUND Cardiac tumours are rare, and clinical manifestations depend on the anatomical location. Symptoms can be the result of cardiac outflow anomalies, constitutional features such as fever, loss of weight, and/or paraneoplastic manifestations such as arthritis. To date, there has only been one other case report in the literature of cardiac sarcoma presenting as paraneoplastic arthropathy. CASE PRESENTATION A 52-year-old woman presented with acute onset corticosteroid-resistant inflammatory polyarthralgia, clubbing and a systolic murmur. Transthoracic echocardiogram revealed a dilated left atrium with an echogenic mass and brain magnetic resonance imaging revealed multiple embolic infarcts. Histopathology following emergency resection showed a Grade 3 left atrial intimal sarcoma. The polyarthralgia and clubbing resolved soon after tumour removal. The patient went on to receive chemotherapy and remains in remission. CONCLUSIONS This case highlights the rare paraneoplastic association of cardiac sarcoma and arthropathy.
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Affiliation(s)
- Natasha Ung
- Department of Rheumatology, Westmead Hospital, Cnr Hawkesbury Road and Darcy Road, Westmead, NSW, 2145, Australia
- Westmead Clinical School, Faculty of Medicine and Health Sciences, University of Sydney, Sydney, NSW, Australia
| | - Carmella Gunasingam
- Department of Rheumatology, Westmead Hospital, Cnr Hawkesbury Road and Darcy Road, Westmead, NSW, 2145, Australia
| | - Ken Cai
- Department of Rheumatology, Westmead Hospital, Cnr Hawkesbury Road and Darcy Road, Westmead, NSW, 2145, Australia
- Westmead Clinical School, Faculty of Medicine and Health Sciences, University of Sydney, Sydney, NSW, Australia
| | - Nicholas Manolios
- Department of Rheumatology, Westmead Hospital, Cnr Hawkesbury Road and Darcy Road, Westmead, NSW, 2145, Australia
- Westmead Clinical School, Faculty of Medicine and Health Sciences, University of Sydney, Sydney, NSW, Australia
| | - Angela Bayly
- Department of Tissue Pathology and Diagnostic Oncology, Westmead Hospital, Westmead, NSW, Australia
| | - Phuong Dinh
- Department of Medical Oncology, Westmead Hospital, Westmead, NSW, Australia
| | - Yishay Orr
- Westmead Clinical School, Faculty of Medicine and Health Sciences, University of Sydney, Sydney, NSW, Australia
- Department of Cardiothoracic Surgery, Westmead Hospital, Westmead, NSW, Australia
| | - Preeti Choudhary
- Westmead Clinical School, Faculty of Medicine and Health Sciences, University of Sydney, Sydney, NSW, Australia
- Department of Cardiology, Westmead Hospital, Westmead, NSW, Australia
| | - Peter Wong
- Department of Rheumatology, Westmead Hospital, Cnr Hawkesbury Road and Darcy Road, Westmead, NSW, 2145, Australia.
- Westmead Clinical School, Faculty of Medicine and Health Sciences, University of Sydney, Sydney, NSW, Australia.
- Rural Clinical School, University of New South Wales, Coffs Harbour, NSW, Australia.
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Khalatbari Kani K, Porrino JA, Mulligan ME, Chew FS. Paraneoplastic musculoskeletal disorders: review and update for radiologists. Skeletal Radiol 2023; 52:421-33. [PMID: 35604445 DOI: 10.1007/s00256-022-04074-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 05/11/2022] [Accepted: 05/12/2022] [Indexed: 02/02/2023]
Abstract
Rheumatic paraneoplastic syndromes are rare syndromes that occur at distant sites from the underlying tumor and may involve the bones, joints, fasciae, muscles, or vessels. In the absence of a known tumor, early recognition of a rheumatic syndrome as paraneoplastic permits dedicated work-up for, and potentially early treatment of an occult malignancy. Although there is a continuously growing list of paraneoplastic rheumatic disorders, not all of these disorders have a well-established association with a neoplastic process. The goals of this article are to review the clinical characteristics, diagnostic work-up, and imaging findings of well-documented rheumatic paraneoplastic disorders.
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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.
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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
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Sathiyapalan A, Legault K, van der Pol CB, Meyers BM. Paraneoplastic Polyarthritis in Hepatocellular Carcinoma Treated With Lenvatinib. Hepatology 2021; 74:1705-1707. [PMID: 33709492 DOI: 10.1002/hep.31794] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 01/11/2021] [Accepted: 02/22/2021] [Indexed: 12/26/2022]
Affiliation(s)
- Arani Sathiyapalan
- Department of Oncology, Juravinski Cancer Center, McMaster University, Hamilton, Ontario, Canada
| | - Kimberly Legault
- Division of Rheumatology, Department of Medicine, Hamilton Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Christian B van der Pol
- Department of Diagnostic Imaging, Juravinski Hospital, Hamilton Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Brandon M Meyers
- Department of Oncology, Juravinski Cancer Center, McMaster University, Hamilton, Ontario, Canada
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Manger B, Schett G. Rheumatic paraneoplastic syndromes – A clinical link between malignancy and autoimmunity. Clin Immunol 2018; 186:67-70. [DOI: 10.1016/j.clim.2017.07.021] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Accepted: 07/19/2017] [Indexed: 12/31/2022]
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Abstract
For patients that present with musculoskeletal symptoms, diagnostic procedures carried out by physicians and rheumatologists are primarily aimed at confirming or excluding the occurrence of primary rheumatic diseases. Another important trigger for musculoskeletal disease, however, is the presence of a tumour. Careful clinical investigation and knowledge of the gestalt of musculoskeletal syndromes related to respective tumour entities is of utmost importance for the diagnosis of paraneoplastic rheumatic diseases such as hypertrophic osteoarthropathy, paraneoplastic polyarthritis, RS3PE syndrome, palmar fasciitis and polyarthritis, cancer-associated myositis and tumour-induced osteomalacia. This places great responsibility on rheumatologists in diagnosing malignancies and referring the patient for effective treatment. The selective influence of tumours on musculoskeletal tissue is surprising and indicates that tumours alter tissues such as the periosteum, synovial membrane, subcutaneous connective tissue, fascia, muscles and bones by specific molecular processes. Some of the underlying mechanisms have been unravelled, providing valuable information on the physiologic and pathophysiologic roles of mediators such as vascular endothelial growth factor and fibroblast growth factor 23.
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Affiliation(s)
- Bernhard Manger
- Department of Internal Medicine 3, University of Erlangen-Nuremberg, Ulmenweg 18, D-91054 Erlangen, Germany
| | - Georg Schett
- Department of Internal Medicine 3, University of Erlangen-Nuremberg, Ulmenweg 18, D-91054 Erlangen, Germany
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Plaut MA, El Mahou S, Popa L, Cantagrel A, Mazières B, Laroche M. Systemic vasculitis revealing a benign tumor: a paraneoplastic syndrome? Joint Bone Spine 2006; 73:462-4. [PMID: 16807043 DOI: 10.1016/j.jbspin.2005.08.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2005] [Accepted: 08/18/2005] [Indexed: 11/24/2022]
Abstract
Systemic vasculitis is a rare event in the course of malignant tumors and has not been described in association with benign tumors. We report a case of renal oncocytoma in a patient who presented with digital necrosis, arthralgia, myalgia, and a decline in general health. The symptoms resolved fully after tumor excision, supporting a diagnosis of paraneoplastic syndrome.
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Affiliation(s)
- Marie-Anne Plaut
- Rheumatology Department, Rangueil Teaching Hospital, 1, avenue Jean-Poulhe, 31059 Toulouse, France
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Papagoras C, Kountouras J, Brilakis S, Chatzopoulos D, Zavos C, Topalidis A. Rheumatic-like syndrome as a symptom of underlying gastric cancer. Clin Rheumatol 2006; 26:1029-31. [PMID: 16572285 DOI: 10.1007/s10067-006-0268-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2006] [Revised: 02/22/2006] [Accepted: 02/23/2006] [Indexed: 12/19/2022]
Abstract
Several observations imply that atypical rheumatic manifestations may be associated with occult neoplasia. A 71-year-old woman was admitted to the hospital three times in 2 years. Initially, she was admitted for investigation of an iron-deficient anemia associated with upper intestinal tract symptoms. Endoscopy revealed hiatus hernia, esophagitis, and duodenal ulcer with a Helicobacter pylori infection, but there were no signs of malignancy, and the patient received appropriate drug treatment. Two years later, she presented with arthralgias concerning the upper and lower limbs in an asymmetrical distribution, low fever, and persistence of the anemia, despite the treatment she had received and the fact that her gastrointestinal symptoms had long ceased. Immunological assays showed no specific rheumatic disorder, and the patient was discharged after showing significant improvement with the use of COX-2 selective NSAIDs. Finally, 4 months later, she was readmitted with worsening of the arthralgias, arthritis in the right radiocarpal joint, and severe anemia. Hematemesis that occurred during her hospital stay led to an emergency endoscopy and the diagnosis of gastric adenocarcinoma. Only a few cases have been reported so far concerning rheumatic manifestations as signs of an occult gastric cancer. Thus, there must be some degree of suspicion when dealing with patients with anemia and rheumatic symptoms that cannot be classified into a particular rheumatologic entity, because they might conceal a gastrointestinal malignancy not yet evident.
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Affiliation(s)
- C Papagoras
- 2nd Department of Internal Medicine, General Hospital of Drama, Drama, Greece.
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Abstract
A 63-year-old man with complaints of joint pain and ankle swelling was evaluated. The arthralgias he described were mainly in the knees, elbows, and shoulders. Accompanying swelling and erythema in his left ankle and left second metacarpophalangeal (MCP) joint had recently ensued. His past history revealed acromegaly, somatotropinectomy, and radiotherapy. His neck, bilateral wrist, elbow, and shoulder joints were involved; there was pain and limited range of motion. The MCP joints, being worse than the interphalangeal joints, were likewise involved. His left ankle and MCP joints additionally were swollen and erythematous. Laboratory and radiological evaluations were carried out. Radiological and clinical findings confirmed a diagnosis of rheumatoid arthritis and concurrent acromegalic arthropathy. The patient was treated accordingly. Interestingly, he later developed colon cancer.
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Affiliation(s)
- Levent Ozçakar
- Department of Physical Medicine and Rehabilitation, Hacettepe University Medical School, Ankara, Turkey
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Abstract
Malignancy-associated musculoskeletal syndromes can present in a variety of ways which are not distinguishable from idiopathic rheumatic diseases. Furthermore, there are some rare, but typical syndromes with a high association with neoplasms. To perform a quick and exact diagnosis while avoiding useless invasive and expensive diagnostic procedures is a major challenge for the clinician. This article focuses on the clinical features of paraneoplastic musculoskeletal syndromes and theories about the underlying pathogenesis. We try to highlight those clinical and laboratory aspects which could be a clue to hidden malignancies. Paraneoplastic rheumatic syndromes are rare conditions, but timely recognition can save lives.
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Affiliation(s)
- G H Stummvoll
- Klinische Abteilung für Rheumatologie, Universitätsklinik für Innere Medizin III, Währinger Gürtel 18-20, A-1090 Wien.
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