Cancer polyarthritis resembling rheumatoid arthritis as a first sign of hidden neoplasms: Report of two cases and review of the literature

Abstract

Recent onset arthritis reminiscent of rheumatoid arthritis (RA) may be an early manifestation of an occult malignancy. In this report, we present two patients with cancer-associated polyarthritis. Both suffered from symmetric polyarthritis when initially visiting their physicians and did not achieve relief when treated with non-steroidal anti-rheumatic drugs (NSAIDs). In both patients, subsequent work-up led to the diagnosis of an underlying malignancy. One patient suffered from small cell lung cancer (SCLC), while the other was diagnosed with adenocarcinoma of the colon. In both, the arthritis spontaneously disappeared after successful treatment of the malignancy, i.e. chemotherapy and tumor resection, respectively. We discuss these cases in view of the existing literature, since awareness of the entity of cancer polyarthritis is necessary for its timely treatment and may potentially be life-saving.

Migrating Polyarthritis as a Feature of Occult Malignancy: 2 Case Reports and a Review of the Literature

“…Pfitzenmeyer et al [ 58 ] later added the absence of characteristic radiologic lesions to the list of typical features ( Box 1 ). These features have been supported by recent case reviews [ 2 , 3 , 8 , 10 ]. It is now well recognised that rheumatic syndromes often precede the diagnosis of malignant disease [ 1 – 3 , 8 , 57 ].…”

“…These features have been supported by recent case reviews [ 2 , 3 , 8 , 10 ]. It is now well recognised that rheumatic syndromes often precede the diagnosis of malignant disease [ 1 – 3 , 8 , 57 ]. Racanelli et al found that, in patients with solid tumours, only 11.5% had a malignancy diagnosed at the time of their rheumatic presentation, while 88.5% were diagnosed after their initial presentation [ 59 ].…”

“…Hypertrophic osteoarthropathy, dermatomyositis, paraneoplastic vasculitis, and most recently palmar fasciitis have all been described as paraneoplastic disorders [ 1 , 9 ]. However, carcinomatous polyarthritis remains a rare and poorly understood clinical entity [ 2 , 3 ]. CP is historically defined by the following criteria [ 1 , 2 ]: It must occur during the course of an identified malignant disease or precede clinical evidence of a malignancy.…”

“…Both may present over the course of weeks to months with similar signs and symptoms, namely, soft tissue swelling, limited range of motion of affected joints, and morning stiffness [ 3 , 9 , 11 – 16 ]. Features suggestive of chronic disease and inflammation (anaemia, elevated ESR/CRP) are also seen [ 2 , 3 , 11 – 13 , 16 , 20 , 22 , 28 , 29 , 42 , 49 , 55 ]. The joint fluid generally shows nonspecific inflammatory changes [ 1 , 2 , 11 , 16 , 17 ].…”

“…Malignant disease may be associated with a wide variety of musculoskeletal syndromes [ 1 – 3 ]. Mechanisms include direct local invasion of the primary tumor, metastasis, and synovial response to juxta-articular masses.…”