Rheumatic disorders clues to occult neoplasia: general aspects

Rheumatic manifestations of cancer are described in a joint manner, wether they are paraneoplastic or metastatic in nature. The spectrum of rheumatic disorders associated with cancer includes over 30 conditions, most of which have no distinguishing features from rheumatic disorders in a patient population without cancer. In the majority of these patients, the symptoms of cancer are found by routine physical and laboratory examinations. For more challenging situations, a series of supplimentary findings are described that suggest the presence of a hidden neoplasm and may justify malignancy evaluation: 1. “Cancerpolyarthritis” - coexistence of several of the following features suggests an occult neoplasm: advanced age at presentation of polyarthritis; explosive onset with asymmetric, swallen, tender joints; predilection for the lower extremities and sparing of the small joints and wrists; absence of serum rheumatoid factor; mild onspecific synovitis on synovial biopsy 2. The presence of monoclonal gammopathy in a patient with typical rheumatoid arthritis is a clue to the coexistance or future development of a hematological malignancy; 3. Palmar fasciitis in the presence of arthritis strongly suggests a hidden cancer; 4. Eosinophilic fasciitis that is unresponsive to steroid therapy; 5. Raynaudʹs phenomenon first presenting at the age of 50 years or more, often with asymetric involvement of the fingers and evolution to necrosis; 6. Cutaneous leukocytoclastic vasculitis, when apparently idiopathic and first occurring at the age of 50 years or more; 7. The inconsistent response to corticoid and/or chemotherapy of some rheumatic disorders.