THE COMORBID CONDITIONS IN RHEUMATOLOGICAL PRACTICE: PARANEOPLASTIC SYNDROME PROBLEM

Abstract

The malignant tumor, irrespective of its localization and stage of its development, is capable to provoke complex aggressive autoimmune and metabolic responses. A significant proportion of these are paraneoplastic rheumatic syndromes that «successfully» mimic common rheumatic diseases, sometimes being little different from their typical clinical course. Immune reactions against tumor cells and cross-reactivity between tumor and physiological antigens leads to an autoimmune condition and the formation of a paraneoplastic rheumatic syndrome. The most commonly diagnosed pathology are paraneoplastic rheumatic syndromes, carcinomatous polyarthritis, RS3PEsyndrome, inflammatory myopathy, hypertrophic osteoarthropathy, palmar fasciitis, paniculitis, paraneoplastic vasculitis, polymyalgia rheumatica, scleroderma, secondary gout and lupus-like syndrome. The article presents their characteristics, features of the course and diagnosis, as well as the possibility of symptomatic treatment. The early general clinical symptoms of paraneoplastic rheumatic syndromes before the diagnosis of cancer are presented. The assumption that under commonplace rheumatoid arthritis, scleroderma, generalized inflammatory myopathy or vasculitis masks paraneoplasia is extremely important because it provides an early diagnosis of the malignant disease and greatly increases the chances of successful treatment. Justified suspicion of paraneoplasia, which means intensive tumor search in the early stages, sometimes unsuccessful in unbiased circumstances, helps to avoid unnecessary therapeutic intervention, waste of time and ensure timely treatment of the cancer itself. A clue may be to take into account some aspects of the nature of the debut and the course, at first glance, a common rheumatic disease or syndrome. It is desirable to pay attention to the particular combination of typical rheumatic symptoms in an unexpected combination, the atypical age of the patient for their occurrence, the unusual nature of the joint syndrome, the significant severity of common complaints such as fatigue, general malaise, rapid weight loss and fever. Extremely high activity of markers of systemic inflammation, especially the rate of ESR and the level of C-reactive protein, as well as refractivity to treatment with glucocorticoids, NSAIDs or drugs of basic therapy should be alert. In cases of intense distal edema of the tissues, palmar or plantar fasciitis, inflammatory lesions of the skin and subcutaneous tissue with ulcers in the absence of involvement of organs, oncological concern should occur already at the first treatment of the patient. To search for a tumor with suspected paraneoplastic syndrome, a sequence of diagnostic procedures is recommended, depending on the probability of tumor localization for a particular variant of its course. There are some specific clinical signaling patterns that are highly likely to be associated with malignancy, such as palmar fasciitis with polyarthritis, RS3PE syndrome or hypertrophic osteoarthropathy, atypical course of rheumatic syndrome with therapeutic refractivity, as well as detection of antibodies to TIF1γ or NXP2 in inflammatory myopathy

Keywords

• paraneoplastic syndrome
• rheumatology
• hypertrophic osteoarthropathy
• polymyalgia rheumatica
• palmar fasciitis.