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[风湿病中的副肿瘤综合征]

[Paraneoplastic syndromes in rheumatology].

作者信息

Strunz Patrick-Pascal, Schmalzing Marc

机构信息

Medizinische Klinik und Poliklinik II, Schwerpunkt für Rheumatologie/Klinische Immunologie, Universitätsklinikum Würzburg, Oberdürrbacher Str. 6, 97080, Würzburg, Deutschland.

出版信息

Z Rheumatol. 2023 Apr;82(3):212-219. doi: 10.1007/s00393-022-01314-1. Epub 2023 Jan 23.

Abstract

Paraneoplastic syndromes in rheumatology are a group of canonical rare rheumatic diseases with musculoskeletal involvement that occur in close temporal and causal association with malignancies. Knowledge of these possibly enables a prognostically relevant early diagnosis of the underlying malignant disease. In the era of immune checkpoint inhibitor treatment, there are first indications of an increase in the incidence and severity of paraneoplastic syndromes, so that they are becoming of increasing importance for the practicing rheumatologist. These nine syndromes, paraneoplastic arthritis, palmar fasciitis and polyarthritis, remitting seronegative symmetrical synovitis with pitting edema, pancreatic panniculitis with polyarthritis, paraneoplastic vasculitis, cancer-associated myositis, hypertrophic osteoarthropathy (Marie-Bamberger), eosinophilic fasciitis and tumor-induced osteomalacia, usually occur with characteristic courses and sometimes pathognomonic clinical manifestations, which are presented in this article accompanied by the rational use of a diagnostic algorithm for tumor detection. With frequently disappointing therapeutic response to glucocorticoids, nonsteroidal antirheumatic drugs and immunosuppressants, treatment of the underlying malignant disease represents the crucial step in the treatment of paraneoplastic syndromes.

摘要

风湿科的副肿瘤综合征是一组典型的罕见风湿性疾病,累及肌肉骨骼系统,与恶性肿瘤在时间和因果关系上密切相关。了解这些综合征可能有助于对潜在恶性疾病进行具有预后意义的早期诊断。在免疫检查点抑制剂治疗时代,有初步迹象表明副肿瘤综合征的发病率和严重程度有所增加,因此它们对执业风湿病学家的重要性日益凸显。这九种综合征,即副肿瘤性关节炎、掌腱膜挛缩症和多关节炎、伴有凹陷性水肿的缓解性血清阴性对称性滑膜炎、伴有多关节炎的胰腺性脂膜炎、副肿瘤性血管炎、癌症相关性肌炎、肥大性骨关节病(Marie-Bamberger病)、嗜酸性筋膜炎和肿瘤诱导的骨软化症,通常具有特征性病程,有时还有具有诊断意义的临床表现,本文将介绍这些表现,并合理运用肿瘤检测诊断算法。由于对糖皮质激素、非甾体类抗风湿药和免疫抑制剂的治疗反应常常令人失望,治疗潜在的恶性疾病是副肿瘤综合征治疗的关键步骤。

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