Migratory Polyarthritis as a Paraneoplastic Syndrome

Abstract

Carcinomatous polyarthritis (CP) is a rare paraneoplastic disorder that has been associated with a variety of solid tumors. It presents in a similar manner to other polyarticular disorders and often precedes detection of the underlying malignancy, making recognition critical. CP responds to the treatment of the neoplastic process. We present a patient who initially presented with asymmetric inflammatory polyarthritis who was later diagnosed with bronchogenic carcinoma. Following the case report we present our learning objectives, which include the differential diagnosis of inflammatory polyarthritis, diagnostic approach to CP, and features that distinguish it from other more common causes of polyarthritis. We conclude with a brief discussion of the pathophysiology and management of CP.KEY WORDS: carcinomatous polyarthritis; migratory arthritis; paraneoplastic syndrome.

Paraneoplastic rheumatologic syndromes

“…A two-way relationship exists in that a malignancy can arise in the setting of preexisting rheumatic disease or as a result of its treatment and certain treatments for cancer manifest rheumatic syndromes. Laboratory findings are also not specific, especially in this elderly population with underlying malignancy: rheumatoid factor was detected in six of 13 patients in one series [5]. They result from substances released from tumor cells like hormones, peptides, antibodies, or from immunologic and other host reactions to the tumor.…”

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Purpose of review

To describe rheumatic syndromes that can be a paraneoplastic manifestation of an underlying malignancy. A paraneoplastic polyarthritis affecting the small joints has also been described [5]. In the absence of a defined pathogenic link between the malignancy and the rheumatic syndrome, the association between these diseases has been based on concurrence and a parallel clinical course.

Recent findings

This is an updated review of paraneoplastic presentations of synovitis, bone disease, myositis, and vasculitis.

Summary

Although paraneoplastic rheumatic syndromes are rare, clinicians should be aware that they can be the first sign of an occult malignancy and that early recognition is vital for early cancer diagnosis and treatment.

Keywords cancer-associated myositis, paraneoplastic bone disease, paraneoplastic synovitis, paraneoplastic vasculitis

PARANEOPLASTIC JOINT DISEASE

Paraneoplastic joint disease can have variable presentations.

PARANEOPLASTIC POLYARTHRITIS

A migratory or additive nonerosive, nondeforming, asymmetric polyarthritis of explosive onset, involving more commonly large joints and sparing the wrists and hands, accompanied by constitutional symptoms and elevated markers of inflammation has been described in older patients in association with an underlying malignancy [3,4].

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Bicalutamide-Associated Acute Liver Injury and Migratory Arthralgia: A Rare but Clinically Important Adverse Effect

“…Cases have also been reported on migratory polyarthralgias as a paraneoplastic phenomenon such as carcinomatous polyarthritis, which is a diagnosis of exclusion [12]. Several medications have been reported as causative agents for migratory polyarthritis including clopidogrel and propylthiouracil [11, 13]. …”

A can of red herrings

“…Our patient presented with a paraneoplastic polyarthritis associated with rheumatoid factor and anti‐CCP antibody positivity, mimicking RA. Paraneoplastic polyarthritis has been reported in a number of solid tumors including lung, gastric, colon, breast, ovarian, laryngeal and pancreatic tumors associated with rheumatoid factor positivity in ≈ 10–20% of patients 19 . Anti‐CCP antibody positivity in paraneoplastic polyarthritis has only been recognized recently in case reports of metastatic pancreatic cancer and adenocarcinoma of the lung 17,18 .…”

“…Paraneoplastic polyarthritis has been reported in a number of solid tumors including lung, gastric, colon, breast, ovarian, laryngeal and pancreatic tumors associated with rheumatoid factor positivity in 10-20% of patients. 19 Anti-CCP antibody positivity in paraneoplastic polyarthritis has only been recognized recently in case reports of metastatic pancreatic cancer and adenocarcinoma of the lung. 17,18 There are no previous reports of anti-CCP antibody positivity in a lymphoproliferative disease on its own.…”