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Objectives-To review the autoimmune and rheumatic manifestations of patients with malignancy. Methods-A Medline search of all published papers using keywords related to malignancies, autoimmunity, rheumatic diseases, and paraneoplastic syndromes.

Objective. To determine whether the frequency of cancer is increased among patients with systemic sclerosis (SSc).Methods. A retrospective chart review of 248 patients who were followed up prospectively was conducted.Results. Cancers developed in 18 patients (7.3%) during 2,001 patient-years at risk. The most frequent types were cancers of the lung (7 patients) and breast (5 patients). Older age at diagnosis of SSc was a significant risk factor for cancer. Lung cancer was associated with the presence of pulmonary fibrosis. The age-standardized incidence rate for all cancers (7.9/1,000) was 2.1 times the overall rate in the Ontario population (P < 0.0001).Conclusion. The frequency of cancer is increased in patients with SSc.Since the report of alveolar cell carcinoma occurring in patients with systemic sclerosis (SSc; scleroderma) (l), a number of studies have indicated possible associations between SSc and breast, gastro- intestinal, urogenital, and hematologic malignancies (2-5). Several cases of breast cancer were noted to occur in close temporal relationship to the onset of SSc, suggesting an etiopathologic association (2).Whether cancer occurs more frequently in patients with SSc than in the general population is uncertain. Previous reports have shown the frequency of cancer in these patients to be between 3% and 7% (3,5,6), but other studies have found either no malignancies or very low prevalence (6-8). Duncan and Winkelmann (5) found the frequency and types of cancer seen in their large series of scleroderma patients to be similar to that seen in the overall patient population at the Mayo Clinic (Rochester, MN). The results from most published reports, however, are difficult to interpret either because of small numbers of patients or because the studies lacked suitable control populations for reliable comparison. Roumm and Medsger (3) compared the occurrence of cancer in scleroderma patients from the Pittsburgh area with National Cancer Survey statistics and found a slight increase in frequency among the scleroderma patients after adjustment for age and sex.To help clarify this issue, we reviewed the health records of 248 patients with SSc who had been followed prospectively over a 1Cyear period, for the occurrence of cancer. The observed frequency was standardized for age and compared with the incidence of cancer in the province of Ontario. PATIENTS AND METHODSThe health records of 248 patients who attended the Scleroderma Clinic at the Wellesley Hospital between 1978 and 1992 and were being followed up as part of an ongoing

Objective. To estimate the risk of cancer in patients with systemic lupus erythematosus (SLE).Methods. Patients with SLE (n = 724) have been followed prospectively, for 24 years, at the University of Toronto Lupus Clinic. The diagnosis of cancer was confirmed by histologic or autopsy reports. Standardized rates of cancer and standardized incidence rates (SIR) (ratio of observed-to-expected cancers) were used to estimate the risk for cancers.Results. Twenty-four cancers were identified in 23 SLE patients (3.2%) during 7,233 patient-years of followup. Compared with the Ontario population, the overall estimated risk for all cancers was not increased in the lupus cohort (SIR 1.08, 95% confidence interval 0.70-1.62). A 4

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The aim of this study was to evaluate the effectiveness of balneotherapy on patients with fibromyalgia (FM) at the Dead Sea. Forty-eight patients with FM were randomly assigned to a treatment group receiving sulfur baths and a control group. All participants stayed for 10 days at a Dead Sea spa. Physical functioning, FM-related symptoms, and tenderness measurements (point count and dolorimetry) were assessed at four time points: prior to arrival at the Dead Sea, after 10 days of treatment, and 1 and 3 months after leaving the spa. Physical functioning and tenderness moderately improved in both groups. With the exception of tenderness threshold, the improvement was especially notable in the treatment group and it persisted even after 3 months. Relief in the severity of FM-related symptoms (pain, fatigue, stiffness, and anxiety) and reduced frequency of symptoms (headache, sleep problems, and subjective joint swelling) were reported in both groups but lasted longer in the treatment group. In conclusion, treatment of FM at the Dead Sea is effective and safe and may become an additional therapeutic modality in FM. Future studies should address the outcome and possible mechanisms of this treatment in FM patients.

Background: Chronic pain may be treated by medical cannabis. Yet, there is scarce evidence to support the role of medical cannabis in the treatment of fibromyalgia. The aim of the study was to investigate the characteristics, safety, and effectiveness of medical cannabis therapy for fibromyalgia. Methods: A prospective observational study with six months follow-up period based on fibromyalgia patients who were willing to answer questionnaire in a specialized medical cannabis clinic between 2015 and 2017. Results: Among the 367 fibromyalgia patients, the mean age was 52.9 ± 15.1, of whom 301 (82.0%) were women. Twenty eight patients (7.6%) stopped the treatment prior to the six months follow-up. The six months response rate was 70.8%. Pain intensity (scale 0–10) reduced from a median of 9.0 at baseline to 5.0 (p < 0.001), and 194 patients (81.1%) achieved treatment response. In a multivariate analysis, age above 60 years (odds ratio [OR] 0.34, 95% C.I 0.16–0.72), concerns about cannabis treatment (OR 0.36, 95% C.I 0.16–0.80), spasticity (OR 2.26, 95% C.I 1.08–4.72), and previous use of cannabis (OR 2.46 95% C.I 1.06–5.74) were associated with treatment outcome. The most common adverse effects were mild and included dizziness (7.9%), dry mouth (6.7%), and gastrointestinal symptoms (5.4%). Conclusion: Medical cannabis appears to be a safe and effective alternative for the treatment of fibromyalgia symptoms. Standardization of treatment compounds and regimens are required.

Fibromyalgia (FS) is an idiopathic chronic pain syndrome defined by widespread non-articular musculoskeletal pain and generalised tender points. As there is no effective treatment, patients with this condition have impaired quality of life (QoL). The aim of this study was to assess the possible effect of balneotherapy at the Dead Sea area on the QoL of patients with FS. Forty-eight subjects participated in the study; half of them received balneotherapy, and half did not. Their QoL (using SF-36), psychological well-being and FS-related symptoms were assessed prior to arrival at the spa hotel in the Dead Sea area, at the end of the 10-day stay, and 1 and 3 months later. A significant improvement was reported on most subscales of the SF-36 and on most symptoms. The improvement in physical aspects of QoL lasted usually 3 months, but on psychological measures the improvement was shorter. Subjects in the balneotherapy group reported higher and longer-lasting improvement than subjects in the control group. In conclusion, staying at the Dead Sea spa, in addition to balneotherapy, can transiently improve the QoL of patients with FS. Other studies with longer follow-up are needed to support our findings.