Rheumatic Paraneoplastic Syndromes and Malignancies With Rheumatic Manifestations

Introduction

• Complex relationship between cancer and rheumatic diseases.
• Bidirectional influences:
  • Rheumatic diseases can increase cancer risk (inflammation, treatments).
  • Cancer or treatments can cause autoimmune/rheumatic manifestations.
• Focus: features of rheumatic paraneoplastic syndromes that indicate underlying malignancy.

Paraneoplastic Syndromes

• Definition: Rare syndromes mediated by factors from tumors, not directly by the tumor.
• Clinical manifestations often involve:
  • Joints
  • Muscles
  • Fasciae
  • Vessels
  • Bones
• Causality must be shown according to Bradford Hill Criteria:
  • Strength, specificity, and temporal relationship between rheumatic symptoms and tumor diagnosis crucial.
• Symptoms should appear simultaneously or within 3 years of malignancy detection.
• Symptoms often resolve after successful elimination of the tumor.

Key Points

• Knowledge of paraneoplastic syndromes enhances diagnosis and treatment timelines.
• Common musculoskeletal manifestations linked to malignancies:
  • Paraneoplastic arthritis
  • Palmar fasciitis and polyarthritis syndrome (PFPAS)
  • Remitting seronegative symmetric synovitis with pitting edema (RS3PE)
  • Erythromelalgia
  • Paraneoplastic vasculitis
  • Hypertrophic osteoarthropathy
  • Eosinophilic fasciitis
  • Tumor-induced osteomalacia
  • Cancer-associated myositis and scleroderma

Paraneoplastic Arthritis (PA)

• Characteristics:
  • Acute, asymmetric polyarthritis (34%), oligoarthritis (48%), monoarthritis (18%).
  • Markedly elevated inflammation markers.
• Diagnostic challenge:
  • 23% test positive for rheumatoid factor.
  • Atypical joint involvement patterns and poor response to corticosteroids suggest malignancy.

Palmar Fasciitis and Polyarthritis Syndrome (PFPAS)

• Symptoms:
  • Swollen, painful palms and fingers (