Cocquempot K, Defuentes G, Duron-Martineau S, Berets O, Vaylet F, Margery J
Service de médecine interne, hôpital d'instruction des armées Percy, 101, avenue Henri-Barbusse, 92140 Clamart, France.
Rev Mal Respir. 2013 Jan;30(1):67-70. doi: 10.1016/j.rmr.2012.06.015. Epub 2012 Oct 25.
Polymyalgia rheumatica is an inflammatory condition belonging to the connective tissue diseases, which occurs quite frequently in the elderly. Previously, cases have been reported in association with malignant tumours, in a synchronous fashion or prior to the appearance of the cancer. In these cases, the polymyalgia rheumatica is considered to be a paraneoplastic syndrome. We report the cases of a 63-year-old woman and a 58-year-old man with severe proximal girdle pain associated to a high-level of systemic inflammatory markers and a diagnosis of polymyalgia rheumatica was made. In the face of a lack of ineffectiveness of analgesic and anti-inflammatory treatments, an intensive investigation was undertaken which in both cases revealed an adenocarcinoma of the lung. The rheumatic manifestations responded well to chemotherapy targeting the lung tumour. We present here a review of the literature to give prominence to the diagnostic pitfalls that can occur around paraneoplastic polymyalgia rheumatica. The presence of therapeutic resistance at the onset of treatment and other atypical features may suggest the presence of an occult malignancy.
风湿性多肌痛是一种属于结缔组织疾病的炎症性病症，在老年人中相当常见。此前，已有与恶性肿瘤相关的病例报道，肿瘤与风湿性多肌痛可同时出现，或在癌症出现之前出现。在这些病例中，风湿性多肌痛被认为是一种副肿瘤综合征。我们报告了一名63岁女性和一名58岁男性的病例，他们均有严重的近端肩带疼痛，伴有高水平的全身炎症标志物，诊断为风湿性多肌痛。鉴于镇痛和抗炎治疗无效，进行了深入检查，结果在两例中均发现了肺癌。针对肺部肿瘤的化疗使风湿性表现得到了良好缓解。我们在此对文献进行综述，以突出副肿瘤性风湿性多肌痛可能出现的诊断陷阱。治疗开始时存在治疗抵抗及其他非典型特征可能提示存在隐匿性恶性肿瘤。
