Gastric Adenocarcinoma Presenting as a Rheumatoid Factor and Anti-cyclic Citrullinated Protein Antibody-Positive Polyarthritis: A Case Report and Review of Literature

Abstract

A 64-year-old male presented with a 6-month history of symmetric polyarthritis involving proximal interphalangeal joints and metacarpophalangeal joints of the hands, wrists, and ankles. Associated symptoms included vomiting, progressive fatigue, and weight loss. Laboratory results showed microcytic anemia, leukocytosis, thrombocytosis, elevated C-reactive protein and erythrocyte sedimentation rate, and rheumatoid factor (RF) and anti-cyclic citrullinated protein (ACPA) antibody positivity. Joints radiographs were normal, without erosions. Upper endoscopy and gastric endoscopic ultrasonography showed a gastric adenocarcinoma with lymphatic involvement. Intraoperatively, peritoneal carcinomatosis was documented, and the patient started palliative chemotherapy. A paraneoplastic seropositive arthritis was assumed, and treatment with low-dose prednisolone and hydroxychloroquine was started. Arthritis remission was achieved and sustained up to 18 months of follow-up, although gastric cancer progression was documented. We describe a unique phenotype of paraneoplastic arthritis (PA) presenting as a seropositive (RF and ACPA positivity) rheumatoid arthritis (RA) with a good response to both low dose corticosteroids and hydroxychloroquine therapy. We also review the literature of PA, mostly the RA-like pattern, and the association between PA and ACPA positivity. This case highlights the importance of considering underlying cancer in elderly male patients, presenting with polyarthritis and systemic symptoms, even in those with ACPA-positive RA-like arthritis.

Paraneoplastic arthritides: an up-to-date case-based systematic review

“…Bahat et al [9] the same year presented the case of 3 patients (2 with colon adenocarcinoma and 1 with acute immunoblastic leukemia -AIL) with a symmetric polyarthritis and negative RF as well as ACPA, mimicking a seronegative RA. Ochi et al [10], Rabah et al [11], Silvèrio-Antònio et al [12] described patients affected by gastric cancers developing a symmetrical polyarthritis mimicking a traditional rheumatoid pattern. To date, Levi Sandri et al [13] are the only group of study who have described an RA-like polyarthritis in a 19 year old boy diagnosed with a follicular dendritic cell sarcoma of the liver.…”

Hematolojik Malignitesi Ve Solid Organ Tümörü Olan Hastalarda RF VE ANTİ-CCP Pozitiflik Oranlarının Saptanması

“…Bu antikorlar sitrulin içeren sentetik peptidlerin geliştirilmesi sayesinde ELİSA yöntemiyle kolayca tespit edilebilmektedir [10]. RF ve anti-CCP vaka sunumlarında ve çalışmalarda PA ile RA, ERA ve diğer romatolojik hastalıklar ayırımında kullanılabilirliği araştırılan belirteçlerdendir [11]. Çalışmalarda romatolojik nedenli artritlerde bu iki belirtecin sıklığı artmış gösterilmekle birlkikte hematolojik malignite ve solid organ tümörü gelişen hastalarda RF ve anti-CCP sıklığını veren bir çalışma yoktur.…”