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[Polymyalgia rheumatica and malignant neoplasms. A report of 3 cases]
P Manganelli1, G Ferraccioli, R Passalacqua
1II Divisione medica e Reumatologia, Usl 4, Parma.
Abstract:
Polymyalgia rheumatica (PMR) is an inflammatory disease which mainly affects elderly patients and is highly responsive to steroid therapy. PMR can be associated with giant cell arteritis and, less frequently, with malignancy. The authors describe three cases of paraneoplastic PMR. In one patient PMR has been the initial manifestation of a B-cell non-Hodgkin lymphoma, in two of a malignant neoplasm of the gastrointestinal system. In two patients the response to steroid therapy was documented. A careful clinical evaluation and a long term follow-up is needed before considering PMR an idiopathic disease.
Insights
Polymyalgia rheumatica (PMR) can be an early sign of cancer. This inflammatory condition in elderly patients may indicate underlying malignancy, requiring thorough investigation beyond typical steroid treatment.
Area of Science:
- Rheumatology
- Oncology
- Internal Medicine
Background:
- Polymyalgia rheumatica (PMR) is an inflammatory condition primarily affecting older adults.
- PMR typically responds well to corticosteroid treatment.
- PMR can be linked to giant cell arteritis and, less commonly, to cancer.
Observation:
- This study presents three cases of paraneoplastic polymyalgia rheumatica.
- In one case, PMR preceded the diagnosis of B-cell non-Hodgkin lymphoma.
- In two cases, PMR was associated with gastrointestinal malignancies.
Findings:
- Two patients with paraneoplastic PMR showed a documented response to steroid therapy.
- Paraneoplastic PMR can mimic idiopathic PMR, even with steroid responsiveness.
- Malignancy should be suspected in elderly patients presenting with new-onset PMR.
Implications:
- A comprehensive clinical evaluation and extended follow-up are crucial for patients with PMR.
- Considering malignancy is essential before diagnosing PMR as idiopathic.
- Early detection of paraneoplastic PMR can improve patient outcomes by addressing the underlying cancer.