Cancer and autoimmunity: autoimmune and rheumatic features in patients with malignancies

Objectives-To review the autoimmune and rheumatic manifestations of patient s with malignancy. Methods-A Medline search of all published papers using keywords related to malignancies, autoimmunity, rheumatic diseases, and paraneoplastic syndrome s. Results-Patients with malignant diseases may develop autoimmune phenomena a na rheumatic diseases as a result of (a) generation of autoantibodies again st various autoantigens, including oncoproteins (P185, 1-myc, c-myc, c-myb) , tumour suppression genes (P53), proliferation associated antigens (cyclin A, B1, D1, E; CENP-F; CDK, U3-RNP), onconeural antigens (Hu, Yo, Ri, Tr), cancer/testis antigens (IMAGE, GAGE, RAGE, SSX, ESO, SCP, CT7), and rheumat ic disease associated antigens (RNP, Sm). The clinical significance of the various autoantibodies is not clear. Anti-oncoprotein and anti-tumour suppr ession gene antigens are detected before the diagnosis of the cancer or in the early stages of the malignant disease, suggesting a potential diagnosti c or prognostic role. Anti-onconeural antibodies are pathogenic and are ass ociated with specific clinical neurological syndromes (anti-Hu syndrome and others). (b) Paraneoplastic syndromes,a wide range of clinical syndromes, including classic autoimmune rheumatic diseases that develop among patients with cancer. (r) Rheumatism after chemotherapy, a clinical entity characte rised by the development of musculoskeletal symptoms after combination chem otherapy for malignancy Conclusion-Autoimmune and rheumatic features are not rare among patients wi th malignancies. They are the result of various diverse mechanisms and occa sionally they may be associated with serious clinical entities.