Abstract
It is well established that some rheumatic syndromes (RS) are associated with several hematological malignancies. We aimed to describe the clinical course of patients with hematological malignancies mimicking RS. We studied a series of four patients presenting with apparent RS who were eventually diagnosed with hematological malignancies, and reviewed the relevant literature. Our series consisted of 4 patients, with a mean age of 62.8 ± 20.3 years, who presented to our rheumatology unit between December 2012 and March 2018. Two patients were initially diagnosed with polyarthritis. One of these patients was eventually diagnosed with multiple myeloma and amyloidosis and the other was diagnosed with angioimmunoblastic T-cell lymphoma. The third patient was initially diagnosed with migratory arthritis and was eventually diagnosed with acute myeloid leukemia. The fourth patient was initially diagnosed with giant cell arteritis and eventually diagnosed with anaplastic large T-cell lymphoma. All the patients displayed a very good response to corticosteroid treatment. Vigilance for occult malignancy is essential in the diagnostic workup of RS. A good response to corticosteroids may constitute a major diagnostic pitfall in patients with hematological malignancies presenting with an apparent RS. In these cases, subtle clinical and laboratory features should elicit the clinician to seek for an occult malignancy.
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References
Naschitz JE, Rosner I (2008) Musculoskeletal syndromes associated with malignancy (excluding hypertrophic osteoarthropathy. Curr Opin Rheumatol 20:100–105
Carsons S (1997) The association of malignancy with rheumatic and connective tissue diseases. Semin Oncol 24:360–372
Shah AA, Casciola-Rosen L, Rosen A (2015) Review: cancer-induced autoimmunity in the rheumatic diseases. Arthritis Rheumatol 67:317–326
Joseph CG, Darrah E, Shah AA, Skora AD, Casciola-Rosen LA, Wigley FM, Boin F, Fava A, Thoburn C, Kinde I, Jiao Y, Papadopoulos N, Kinzler KW, Vogelstein B, Rosen A (2014) Association of the autoimmune disease scleroderma with an immunologic response to cancer. Science 343:152–157
Shah AA, Rosen A, Hummers L, Wigley F, Casciola-Rosen L (2010) Close temporal relationship between onset of cancer and scleroderma in patients with RNA polymerase I/III antibodies. Arthritis Rheum 62:2787–2795
Abu-Shakra M, Guillemin F, Lee P (1993) Cancer in systemic sclerosis. Arthritis Rheum 36:460–464
Chen YJ, Wu CY, Huang YL, Wang CB, Shen JL, Chang YT (2010) Cancer risks of dermatomyositis and polymyositis: a nationwide cohort study in Taiwan. Arthritis Res Ther 12:R70
Naschitz JE, Rosner I, Rozenbaum M, Zuckerman E, Yeshurun D (1999) Rheumatic syndromes: clues to occult neoplasia. Semin Arthritis Rheu 29:43–55
Szekanecz E, Andras C, Sandor Z, Antal-Szalmas P, Szanto J, Tamasi L, Kiss E, Szekanecz Z (2006) Malignancies and soluble tumor antigens in rheumatic diseases. Autoimmun Rev 6:42–47
Adamus G (2003) Autoantibody-induced apoptosis as a possible mechanism of autoimmune retinopathy. Autoimmun Rev 2:63–68
Saiki M, Sakai K, Saiki S, Kitagawa Y, Nakanishi M, Hirose G (2005) Induction of humoral responses specific for paraneoplastic cerebellar degeneration-associated antigen by whole recombinant yeast immunization. J Autoimmun 24:203–208
Lorusso L, Hart IK, Ferrari D, Ngonga GK, Gasparetto C, Ricevuti G (2007) Autonomic paraneoplastic neurological syndromes. Autoimmun Rev 6:162–168
Abu-Shakra M, Buskila D, Ehrenfeld M, Conrad K, Shoenfeld Y (2001) Cancer and autoimmunity: autoimmune and rheumatic features in patients with malignancies. Ann Rheum Dis 60:433–441
Avina-Zubieta JA, Galindo-Rodriguez G, Lavalle C (1998) Rheumatic manifestations of hematologic disorders. Curr Opin Rheumatol 10:86–90
Rennie JA, Auchterlonie IA (1991) Rheumatological manifestations of the leukaemias and graft versus host disease. Bailliere Clin Rheum 5:231–251
Weinberger A, Schumacher HR, Schimmer BM, Myers AR, Brogadir SP (1981) Arthritis in acute leukemia. Clinical and histopathological observations. Arch Intern Med 141:1183–1187
Mariette X, de Roquancourt A, d’Agay MF, Gisselbrecht C, Clauvel JP, Oksenhendler E (1988) Monarthritis revealing non-Hodgkin’s T cell lymphoma of the synovium. Arthritis Rheum 31:571–572
Colby TV (2012) Current histological diagnosis of lymphomatoid granulomatosis. Modern Pathol 25(Suppl 1):S39–S42
Enright H, Jacob HS, Vercellotti G, Howe R, Belzer M, Miller W (1995) Paraneoplastic autoimmune phenomena in patients with myelodysplastic syndromes: response to immunosuppressive therapy. Brit J Haematol 91:403–408
Shirota T, Hayashi O, Uchida H, Tonozuka N, Sakai N, Itoh H (1993) Myelodysplastic syndrome associated with relapsing polychondritis: unusual transformation from refractory anemia to chronic myelomonocytic leukemia. Ann Hematol 67:45–47
Castro M, Conn DL, Su WP, Garton JP (1991) Rheumatic manifestations in myelodysplastic syndromes. J Rheumatol 18:721–727
Andras C, Csiki Z, Ponyi A, Illes A, Danko K (2006) Paraneoplastic rheumatic syndromes. Rheumatol Int 26:376–382
Karmacharya P, Donato AA, Aryal MR, Ghimire S, Pathak R, Shah K, Shrestha P, Poudel D, Wasser T, Subedi A, Giri S, Jalota L, Olive A (2016) RS3PE revisited: a systematic review and meta-analysis of 331 cases. Clin Exp Rheumatol 34:404–415
Li H, Altman RD, Yao Q (2015) RS3PE: clinical and research development. Current Rheumatol Rep 17:49
Sridhar KS, Lobo CF, Altman RD (1998) Digital clubbing and lung cancer. Chest 114:1535–1537
Enomoto M, Takemura H, Suzuki M, Yuhara T, Akama T, Yamane K, Sumida T (2000) Palmar fasciitis and polyarthritis associated with gastric carcinoma: complete resolution after total gastrectomy. Intern Med 39:754–757
Alexandroff AB, Hazleman BL, Matthewson M, Black CM, Rytina E, Crawford R, Burrows NP (2003) Woody hands. Lancet 361:1344
Racanelli V, Prete M, Minoia C, Favoino E, Perosa F (2008) Rheumatic disorders as paraneoplastic syndromes. Autoimmun Rev 7:352–358
Yamashita H, Ueda Y, Ozaki T, Tsuchiya H, Takahashi Y, Kaneko H, Kano T, Mimori A (2014) Characteristics of 10 patients with paraneoplastic rheumatologic musculoskeletal manifestations. Mod Rheumatol 24:492–498
Kisacik B, Onat AM, Kasifoglu T, Pehlivan Y, Pamuk ON, Dalkilic E, Donmez S, Bilge SY, Yilmaz S, Erdem H, Mercan R, Ozturk MA, Bes C, Soy M, Erten S, Cobankara V, Senel S, Oner FA, Yilmaz S, Emmungil H, Aksu K, Kul S, Cetin GY, Sayarlioglu M (2014) Diagnostic dilemma of paraneoplastic arthritis: case series. Int J Rheum Dis 17:640–645
Evans TI, Nercessian BM, Sanders KM (1994) Leukemic arthritis. Semin Arthritis Rheu 24:48–56
Ehrenfeld M, Gur H, Shoenfeld Y (1999) Rheumatologic features of hematologic disorders. Curr Opin Rheumatol 11:62–67
Loughran TP Jr (1993) Clonal diseases of large granular lymphocytes. Blood 82:1–14
Thomson GT (1994) Non-Hodgkin’s lymphoma presenting as polyarthritis. Br J Rheumatol 33:890
Savin H, Zimmermann B 3rd, Aaron RK, Libbey NP, Khorsand J, Alper JC, Lally EV (1991) Seronegative symmetric polyarthritis in Sezary syndrome. J Rheumatolo 18:464–467
Gridley G, McLaughlin JK, Ekbom A, Klareskog L, Adami HO, Hacker DG, Hoover R, Fraumeni JF Jr (1993) Incidence of cancer among patients with rheumatoid arthritis. J Natl Cancer Inst 85:307–311
McCarty DJ, O’Duffy JD, Pearson L, Hunter JB (1985) Remitting seronegative symmetrical synovitis with pitting edema. RS3PE syndrome. Jama 254:2763–2767
Walker UA, Herbst EW, Ansorge O, Peter HH (1994) Intravascular lymphoma simulating vasculitis. Rheumatol Int 14:131–133
Vitali C, Baglioni P, Vivaldi I, Cacialli R, Tavoni A, Bombardieri S (1991) Erosive arthritis in monoclonal gammopathy of uncertain significance: report of four cases. Arthritis Rheum 34:1600–1605
Alpay N, Artim-Esen B, Kamali S, Gul A, Kalayoglu-Besisik S (2009) Amyloid arthropathy mimicking seronegative rheumatoid arthritis in multiple myeloma: case reports and review of the literature. Amyloid 16:226–231
Fujishima M, Komatsuda A, Imai H, Wakui H, Watanabe W, Sawada K (2003) Amyloid arthropathy resembling seronegative rheumatoid arthritis in a patient with IgD-kappa multiple myeloma. Intern Med 42:121–124
Katoh N, Tazawa K, Ishii W, Matsuda M, Ikeda S (2008) Systemic AL amyloidosis mimicking rheumatoid arthritis. Intern Med 47:1133–1138
Fautrel B, Fermand JP, Sibilia J, Nochy D, Rousselin B, Ravaud P (2002) Amyloid arthropathy in the course of multiple myeloma. J Rheumatol 29:1473–1481
Mobini M, Shekarriz R, Ali Mohammad Pour R, Zakeri S (2015) inflammatory rheumatologic disorders in patients with myelodysplastic syndromes: a cross-sectional study. Int J Hematol Onco Stem Cell Res 9:22–25
Dasgupta B, Borg FA, Hassan N, Alexander L, Barraclough K, Bourke B, Fulcher J, Hollywood J, Hutchings A, James P, Kyle V, Nott J, Power M, Samanta A, BSR and BHPR Standards, Guidelines and Audit Working Group (2010) BSR and BHPR guidelines for the management of giant cell arteritis. Rheumatology 49:1594–1597
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Bornstein, G., Furie, N., Perel, N. et al. Hematological malignancies mimicking rheumatic syndromes: case series and review of the literature. Rheumatol Int 38, 1743–1749 (2018). https://doi.org/10.1007/s00296-018-4107-0
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DOI: https://doi.org/10.1007/s00296-018-4107-0