Benedek T G
Department of Medicine, Veterans Administration Hospital, University of Pittsburgh School of Medicine, Pennsylvania.
Clin Geriatr Med. 1988 May;4(2):333-55.
Associations between rheumatic diseases and malignant neoplasms are still inferential and based largely on epidemiologic data. Rheumatoid arthritis predisposes weakly to the occurrence of lymphoreticular neoplasms. This is more clearly true of Sjögren's disease, whether or not it is associated with RA. A subset of DM/PM which becomes manifest in close temporal proximity to a neoplasm may be a paraneoplastic reaction, but DM/PM, in general, does not predispose to neoplasia. Scleroderma in its early phase is associated with the development of breast cancer in women, and after a decade or longer, if pulmonary fibrosis has developed, with lung cancer. Of the drugs that have been used to treat these diseases, cyclophosphamide is most strongly implicated as a carcinogenic agent, particularly inducing lymphoreticular neoplasms and carcinoma of the bladder. Musculoskeletal symptoms that may be clues to the existence of cancer may either be caused by invasion of the neoplasm or be mediated by unidentified neurohumoral mechanisms. Except for multiple myeloma, primary neoplasms of skeletal tissues tend to occur under the age of 50 years. Metastatic disease occurs congruently with the age incidence of the primary neoplasm. Metastases may mimic mono- or oligoarticular arthritis if they happen to be periarticular or synovial. These metastases result most often from carcinoma of the lung or, in women, carcinoma of the breast. Hypertrophic pulmonary osteoarthropathy usually is due to carcinomas of the lung other than the small cell variety, and infrequently from other intrathoracic primary or secondary neoplasms. RA may be mimicked. Both skeletal metastases and HPOA are detected with greater sensitivity, but not specificity, by isotopic scanning techniques than by radiography. Of the other paraneoplastic musculoskeletal syndromes, neuromyopathy is the most frequent. It must be distinguished from cachexia, polymyositis, polymyalgia rheumatica, and the myasthenic syndrome. Both neuromyopathy and Eaton-Lambert (myasthenic) syndrome are predominantly associated with small cell carcinoma of the lung and both are best diagnosed by electromyography. Carcinomatous polyarthritis and the palmar fasciitis-arthritis syndrome occur with various neoplasms, although the latter appears to be particularly associated with ovarian carcinomas. The paraneoplastic arthritides test negatively for the rheumatoid factor, but no reliable positive immunochemical clues have as yet been identified.
风湿性疾病与恶性肿瘤之间的关联仍基于推断，且很大程度上是基于流行病学数据。类风湿关节炎与淋巴网状系统肿瘤的发生关联较弱。干燥综合征则更为明显，无论其是否与类风湿关节炎相关。皮肌炎/多肌炎中，一小部分在肿瘤发生的相近时间内出现的病例可能是副肿瘤性反应，但总体而言，皮肌炎/多肌炎不会引发肿瘤。硬皮病早期与女性乳腺癌的发生相关，十年或更长时间后，若出现肺纤维化，则与肺癌相关。在用于治疗这些疾病的药物中，环磷酰胺被认为是最强的致癌剂，尤其会引发淋巴网状系统肿瘤和膀胱癌。可能提示癌症存在的肌肉骨骼症状，要么是由肿瘤侵袭引起，要么是由不明的神经体液机制介导。除多发性骨髓瘤外，骨骼组织的原发性肿瘤往往发生在50岁以下。转移性疾病的发生与原发性肿瘤的年龄发病率一致。如果转移灶恰好位于关节周围或滑膜处，可能会模仿单关节或少关节关节炎。这些转移灶最常见于肺癌，在女性中则最常见于乳腺癌。肥大性肺性骨关节病通常由非小细胞型肺癌引起，很少由其他胸内原发性或继发性肿瘤引起。类风湿关节炎可能会被模仿。与X线摄影相比，同位素扫描技术检测骨骼转移瘤和肥大性肺性骨关节病的敏感性更高，但特异性不强。在其他副肿瘤性肌肉骨骼综合征中，神经病变最为常见。必须将其与恶病质、多发性肌炎、风湿性多肌痛和肌无力综合征相区分。神经病变和伊顿 - 兰伯特（肌无力）综合征都主要与小细胞肺癌相关，两者最好通过肌电图进行诊断。癌性多关节炎和掌腱膜挛缩 - 关节炎综合征可与多种肿瘤同时出现，尽管后者似乎特别与卵巢癌相关。副肿瘤性关节炎的类风湿因子检测为阴性，但尚未发现可靠的阳性免疫化学线索。
