The real evidence for polymyalgia rheumatica as a paraneoplastic syndrome

Abstract

The aim of this study was to systematically consider the evidence for polymyalgia rheumatica (PMR) as a paraneoplastic disease. A systematic review of Medline and Embase was conducted from their inception to February 2017. Risk of bias was assessed using the Newcastle-Ottawa tool. Data were extracted regarding the PMR-cancer association, the types of cancer associated with PMR and the presentation of PMR patients subsequently diagnosed with cancer. Twenty-three full text articles were reviewed from the 1174 unique references identified in the search. Nine articles were included in the final review. There was some evidence of an association between PMR and cancer in the short-term (first 6 to 12 months after diagnosis), but no evidence of an association after this time. Limited evidence suggests that lymphoma, prostate and haematological cancers may be those cancers more commonly diagnosed in those with PMR. There was little evidence to suggest what presenting features may be associated with the development of cancer. There is little evidence of PMR as a true paraneoplastic disease. However, there is reason to be cautious when making the diagnosis of PMR. Clinicians should be aware of this potential association both prior to making a diagnosis and throughout the course of the condition.

The real evidence for polymyalgia rheumatic as a paraneoplastic syndrome

“…We would like to thank Bellan and colleagues for their interest in our recent article regarding polymyalgia rheumatica (PMR) and paraneoplastic syndrome (1,2). We agree with the points they raise and are grateful for the aspects they highlight regarding the need for further research into PMR.…”

A case of inflammatory pseudotumor of the lung presenting as polymyalgia rheumatica

“…Polymyalgia rheumatica (PMR) is a relatively common inflammatory condition that generally occurs in patients 50 years and older, characterized by aching and morning stiffness specifically in the shoulder and pelvic girdles . Though inflammatory pseudotumors have been reported in other rheumatologic conditions, we present a case of an inflammatory pseudotumor of the lung in a patient with clinically appearing PMR.…”

Perspectives and unmet needs in polymyalgia rheumatica. Providing the fundamental framework for the development of new treatment regimes in polymyalgia rheumatica

“…degenerative shoulder conditions, inflammatory arthritides, giant cell arteritis (GCA), endocrine disorders and malignancies (20,21), criteria showing a high specificity is preferred at the expense of high sensitivity. Moreover, the criteria need to be applicable prior to commencement of therapy in order to be useful in clinical trials, that is, specific requirements for GC response should not be incorporated.…”

“…In MRI studies, the presence of extracapsular, i.e. the soft tissues outside synovial cavities, inflammatory changes has been described in both shoulders, pelvic girdle and MCP joints in PMR, whereas it seems to be seldom in RA (20,21,23,25). The spatial resolution of fluorine-18-fluorodeoxyglucose (FDG) PET/CT studies and the short timespan between the PET and CT imaging does not always allow rigorous co-localization of FDG uptake and anatomical structures.…”