Paraneoplastic rheumatic syndromes

Malignant neoplasms are associated with a wide variety of paraneoplastic rh eumatological syndromes. Among these, hypertrophic osteoarthropathy, carcin oma polyarthritis, dermatomyositis/polymyositis, and paraneoplastic vasculi tis are the most frequently recognized. Other less known associations are b ased upon a smaller number of reported patients, and include fasciitis, pan niculitis, erythema nodosum, Raynaud's syndrome, digital gangrene, erythrom elalgia and lupus-like syndromes. Musculoskeletal manifestations of maligna ncy may coincide, follow or antedate the diagnosis of cancer, or herald its recurrence. The clinical course generally parallels that of the primary tu mour, and treatment of the underlying malignancy often results in regressio n of the rheumatic disorder. Awareness that cancer can cause certain non-me tastatic symptoms is important for early diagnosis and treatment of an occu lt neoplasm. Rheumatic manifestations suggesting a hidden cancer include: r apid onset of an unusual inflammatory arthritis clubbing or diffuse bone pa ins in a patient 50 years of age or older, chronic unexplained vasculitis, refractory fasciitis, Raynaud's syndrome unresponsive to vasodilator therap y, rapidly progressive digital gangrene or Lambert-Eaton myasthenic syndrom e. Management consists of control of the underlying cancer and symptomatic treatment of the rheumatic syndrome with non-steroidal anti-inflammatory dr ugs or corticosteroids.