Ciołkiewicz Mariusz, Domysławska Izabela, Ciołkiewicz Agata, Klimiuk Piotr Adrian, Kuryliszyn-Moskal Anna
Department of General and Experimental Pathology, Medical University of Białystok, NZOZ Vitamed Hospice House, Białystok, Poland.
Pol Arch Med Wewn. 2008 Mar;118(3):119-26.
Coexistence of rheumatic and neoplastic diseases may take different forms. Rheumatic paraneoplastic syndromes, including systemic sclerosis, scleroderma-like changes and Raynaud's phenomenon are induced by substances secreted by neoplastic cells and immunological disturbances connected are associated with malignancy. They may precede the clinical manifestation of neoplasm, occur simultaneously or after its diagnosis. In turn, chronic course of rheumatic diseases (Sjögren's syndrome, systemic sclerosis, rheumatoid arthritis, systemic lupus erythematosus, dermatomyositis) by immunologic stimulation may promote carcinogenesis. Genetic, environmental factors (viruses, chemical substances, radiation) and alterations of immunological surveillance may be the cause of both rheumatic and paraneoplastic disorders. Anticancer therapy may cause rheumatic diseases and immunosuppressive agents used in patients with rheumatic syndromes may have carcinogenic effect. Patients with long-standing or atypical course of rheumatic disorders, positive family or personal history of neoplastic disease, positive cancer markers, monoclonal antibodies or presence of other paraneoplastic syndromes should be diagnosed as possibly having occult neoplasm. In this paper we reviewed available literature on coexistence of rheumatic processes and malignancies to attract particular attention to practical aspects of this vital issue.
风湿性疾病与肿瘤性疾病可能以不同形式并存。风湿性副肿瘤综合征，包括系统性硬化症、硬皮病样改变及雷诺现象，是由肿瘤细胞分泌的物质及相关免疫紊乱所诱发，与恶性肿瘤相关。它们可能在肿瘤临床表现之前出现、同时出现或在肿瘤诊断之后出现。反过来，风湿性疾病（干燥综合征、系统性硬化症、类风湿关节炎、系统性红斑狼疮、皮肌炎）的慢性病程通过免疫刺激可能促进致癌作用。遗传、环境因素（病毒、化学物质、辐射）及免疫监视改变可能是风湿性疾病和副肿瘤性疾病的病因。抗癌治疗可能引发风湿性疾病，而用于风湿综合征患者的免疫抑制剂可能具有致癌作用。患有长期或非典型病程的风湿性疾病、有肿瘤性疾病家族史或个人史阳性、癌症标志物阳性、单克隆抗体阳性或存在其他副肿瘤综合征的患者，应被诊断为可能患有隐匿性肿瘤。在本文中，我们回顾了有关风湿性疾病与恶性肿瘤并存的现有文献，以特别关注这一重要问题的实际方面。
