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What musculoskeletal paraneoplastic syndromes are associated with malignancy?
Musculoskeletal paraneoplastic syndromes that are associated with malignancies are outlined in the below table
Musculoskeletal Paraneoplastic Syndrome Associated with Malignancy
| Paraneoplastic Syndrome | Malignancy | Clinical Association |
|---|---|---|
| Myopathy | ||
| DM | Adenocarcinoma, nasopharyngeal cancer (Southeast Asians) | Cancer may precede, coincide, or follow diagnosis of myositis |
| PM | Adenocarcinoma | Lower risk than dermatomyositis |
| Lambert–Eaton | Small cell lung cancer | Often precedes cancer detection |
| Arthropathy | ||
| Hypertrophic osteoarthropathy | Various types | Lung cancer (non-small cell) is most common |
| Amyloidosis | Multiple myeloma | 25% of primary amyloidosis is associated with multiple myeloma |
| Secondary gout | Myeloproliferative disorders | Tumor lysis syndrome |
| Carcinomatous polyarthritis | Solid tumor or hematologic disorders | 80% of women have breast cancer |
| Atypical polymyalgia rheumatica | Renal, lung, colon, myeloma | Unresponsive to corticosteroids after 6 months |
| Remitting seronegative symmetric synovitis with pitting edema, (RS3PE) | Several tumors | Rapid onset wrist, hand arthritis with edema. May have fever. Poor response to prednisone |
| Vascular (uncommon) | ||
| Vasculitis | Lymphoproliferative, various types | Cutaneous >> systemic vasculitis |
| Polyarteritis nodosa | Hairy-cell leukemia | Polyarteritis-like clinically and by arteriography |
| Digital necrosis | Solid, lymphoproliferative | Severe or asymmetric Raynaud’s syndrome onset after the age of 50 years |
| Cryoglobulinemia | Plasma cell dyscrasias, non-Hodgkin’s lymphoma | Purpura, digital ischemia, renal/pulmonary involvement |
| Strokes | Intravascular CNS B-cell lymphoma | Can mimic CNS lupus, positive ANA |
| Cutaneous | ||
| Sweet’s syndrome | Leukemia (acute myeloid leukemia), others | Associated with malignancy in 15% |
| Palmar fasciitis and polyarthritis | Ovarian, breast, gastric, pancreatic | Progressive fibrosis and contractures |
| Scleroderma | Adenocarcinoma (lung) | Women > men; anti-RNAP III |
| Panniculitis | Hematologic > pancreatic | Subcutaneous nodules and arthritis, eosinophilia |
| Erythromelalgia | Myeloproliferative disorders | Severe burning pain, erythema, and warmth primarily in feet |
| Multicentric reticulocytosis | Adenocarcinoma, ovarian, lung, others | Associated with malignancy in 30% |
| Miscellaneous | ||
| Pyogenic arthritis | Colon cancer, multiple myeloma | Intestinal flora cultured, rare cause of primary septic arthritis |
| Lupus-like syndrome | Hairy-cell leukemia, ovary, breast, lymphoma | Polyarthritis, serositis, rash, Raynaud’s, positive ANA |
| Antiphospholipid antibodies | Solid tumors, lymphoproliferative | Association with thrombosis is unclear |
| Oncogenic osteomalacia | Solid tumors; tumors of mesenchymal origin | Bone pain, muscle weakness low phosphorous, elevated FGF23Octreotide scan to localize tumor |
| Sarcoidosis | Solid tumors, lymphoma | Draining lymph nodes show noncaseating granuloma |
| Lymphomatoid granulomatosis | Lymphoma | Angiodestructive lesions, EBV-associated |
ANA, Antinuclear antibody; EBV, Epstein–Barr virus; RNAP III , RNA polymerase III.
