Morel J, Deschamps V, Toussirot E, Pertuiset E, Sordet C, Kieffer P, Berthelot J M, Champagne H, Mariette X, Combe B
Department of Immuno-Rheumatology, Montpellier I University and Lapeyronie Teaching Hospital, 34295 Montpellier, Cedex 5 France.
Ann Rheum Dis. 2008 Feb;67(2):244-7. doi: 10.1136/ard.2007.070086. Epub 2007 Jun 29.
To date, only a few series of patients with paraneoplastic arthritis have been published. The charts of patients with cancer-associated arthritis were collected in order to describe characteristics of this rheumatism.
A questionnaire was created for this study and validated by experts based on specific criteria of inclusion and exclusion. Histology of neoplasia was included.
In all, 16 males and 10 females with a mean (range) age of 57.5 years (28-85) were recruited from 17 nationwide centres in France. Patients presented with symmetric polyarthritis involving wrists and hands (85%) and extra-articular symptoms were frequent (84%). There was no specific biologic or radiographic feature. The mean (range) delay between the diagnosis of rheumatism and neoplasia was 3.6 months (0-21.2). Tumours were usually diagnosed after articular symptoms occurred (88.5%). Twenty patients had a solid cancer, and six a haematological malignancy. Adenocarcinoma of the lungs was the most frequent type of solid cancer (60%). Tumours were diagnosed at an early stage, which may explain the good median survival of 1.21 years (range 0.64-present) with a mean follow-up of 1.9 years (range 0.16-10). The percentage of articular symptoms resolution was significantly higher in patients with solid tumours, as compared to patients with haemopathy (p = 0.007). In cases of tumour relapse, rheumatic symptoms did not recur for 75% of patients.
Underlying neoplasia should be considered in male patients with new onset polyarthritis, smokers, and particularly in patients chronically ill. Additional investigations should then be performed to diagnose cancer at an early stage.
迄今为止，仅有少数关于副肿瘤性关节炎患者系列的报道发表。收集癌症相关性关节炎患者的病历以描述这种风湿病的特征。
为本研究设计了一份问卷，并经专家根据特定的纳入和排除标准进行验证。纳入肿瘤的组织学情况。
共从法国17个全国性中心招募了16名男性和10名女性，平均（范围）年龄为57.5岁（28 - 85岁）。患者表现为累及手腕和手部的对称性多关节炎（85%），关节外症状常见（84%）。没有特定的生物学或影像学特征。风湿病诊断与肿瘤诊断之间的平均（范围）间隔为3.6个月（0 - 21.2个月）。肿瘤通常在关节症状出现后被诊断（88.5%）。20例患者患有实体癌，6例患有血液系统恶性肿瘤。肺腺癌是最常见的实体癌类型（60%）。肿瘤在早期被诊断，这可能解释了中位生存期良好，为1.21年（范围0.64 - 目前），平均随访1.9年（范围0.16 - 10年）。与血液病患者相比，实体瘤患者关节症状缓解的百分比显著更高（p = 0.007）。在肿瘤复发的病例中，75%的患者风湿症状未复发。
对于新发多关节炎的男性患者、吸烟者，尤其是慢性病患者，应考虑潜在的肿瘤。然后应进行进一步检查以便早期诊断癌症。
