Division of Rheumatology, Department of Internal Medicine, University of Missouri School of Medicine, CE 326, DC 043.00, 5 Hospital Drive, Columbia, MO 65212, USA.
Rheumatol Int. 2011 Dec;31(12):1635-8. doi: 10.1007/s00296-009-1294-8. Epub 2009 Dec 15.
A 45-year-old female presented to the rheumatology clinic with complaint of pain and swelling of multiple small joints of the hands and feet. She also complained of cough and shortness of breath onset around the same time. Since her cyclic citrullinated peptide antibody (anti-CCP) and rheumatoid factor tests were positive, rheumatoid arthritis (RA) was diagnosed and she was started on prednisone with plans for additional disease modifying therapy. Chest X-ray showed a small right pleural effusion. While additional pulmonary evaluation was being planned, a few weeks later she presented with dyspnea, fever and tachycardia. Spiral CT showed pulmonary emboli and increased pleural effusion and patient was started on anticoagulation. A chest tube was placed and exudative pleural effusion was drained. Cytology sample from bronchoscopy raised concerns for adenocarcinoma. Open lung biopsy confirmed moderately differentiated adenocarcinoma. The patient died of lung cancer in the hospital 8 weeks from her diagnosis of RA. We describe a case of paraneoplastic polyarthritis with positive anti-CCP antibody test which has not been reported before. We also review the literature on paraneoplastic arthritis which has been described in association with various other malignancies besides lung cancer.
一位 45 岁女性因双手和双脚多个小关节疼痛和肿胀就诊于风湿科。她还主诉在同一时期出现咳嗽和呼吸急促。由于她的环瓜氨酸肽抗体（抗-CCP）和类风湿因子检测呈阳性，因此诊断为类风湿关节炎（RA），并开始服用泼尼松龙，并计划进行其他疾病修正治疗。胸部 X 光显示右侧少量胸腔积液。在计划进行更多肺部评估的同时，几周后她出现呼吸困难、发热和心动过速。螺旋 CT 显示肺栓塞和胸腔积液增加，患者开始接受抗凝治疗。放置了胸腔引流管，排出渗出性胸腔积液。支气管镜检查的细胞学样本提示腺癌。开胸肺活检证实为中分化腺癌。患者在被诊断为 RA 后 8 周死于肺癌。我们描述了一例副肿瘤性多关节炎，其抗 CCP 抗体检测呈阳性，这在此前尚未报道过。我们还回顾了文献中描述的副肿瘤性关节炎，它与肺癌以外的各种其他恶性肿瘤有关。
