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Rheumatism and cancer

Paraneoplasias and rheumatic diseases

Paraneoplasias are accompanying symptoms or clinical signs that are not directly caused by a tumour or its metastases. They are caused by so-called soluble factors such as hormones and cytokines of the tumour, which are produced by the tumour cells or are the result of an immune reaction against these cells.

Paraneoplasias can occur in any organ, most often manifesting in the bones, joints, vessels or muscles. Thus, a number of musculoskeletal symptoms are closely related to malignant cancers. If therapeutic treatment of musculoskeletal symptoms is not successful, malignant underlying forms must be clarified. However, in order to actually consider paraneoplasia, a causal relationship must be established between the symptoms that have occurred.

The following is an example of a typical paraneoplasia with rheumatic complaints.

Hypertrophic osteoarthropathy (HOA)

HOA, also known as Marie-Bamberger syndrome, is a rare disease that results in chronic lung disease. The disease is characterized by a combination of a proliferating periosteum inflammation, drum flail fingers and watch glass nails as well as an oligo- or polysynovitis (inflammation of the synovium of few or many joints). The periosteum thickens within a very short time, especially on long tubular bones, rarely also on the phalanges (finger joints) and arthralgias (joint pain) up to symmetrically distributed arthritis, painful swellings and joint effusions occur. The localization of lamellar bone formation in x-rays is also characteristic. HOA is usually paraneoplastic, but in rare cases it can occur in the family and also in other chronic diseases such as bacterial endocarditis, cirrhosis of the liver, inflammatory bowel disease and Graves' disease. Therefore, a thorough tumour search must be carried out for every patient with the corresponding symptoms. Primarily pulmonary or intrathoracic (within the thorax) malignancies are present.