A polymyalgia rheumatica-like syndrome as presentation of metastatic cancer

A polymyalgia rheumatica-like syndrome is occasionally the first clinical expression of disseminated cancer. Patients admitted to the medical ward of a general hospital during a 10-year period were surveyed for the presence of polymyalgia rheumatica (PMR) in the context of cancer. Five patients were identified with a PMR-like syndrome characterized by prominent systemic symptoms and one or more features dissimilar from PMR, such as a) age of fewer than 50 years, b) only one typical site involved, c) asymmetrical involvement at typical sites, d) additional painful joints, and e) no improvement on 10 mg/d prednisone treatment. There were four men and one woman. The ages ranged from 37 to 84 years. The onset of PMR-like symptoms preceded the initial diagnosis of cancer or of recurrent cancer by 1 to 3 months. On x-ray of the shoulder and pelvic girdles, lytic lesions were observed in one patient. Bone scintigraphy showed pathologic uptake suggestive of metastatic spread, particularly in the symptomatic segments, in all patients. The primary sites of cancer in the five patients were lung (n = 1), kidney (n = 1), colon (n = 2) and unknown (n = 1). Although a search for malignancy may not be justified in patients presenting with typical PMR, the present survey suggests that in patients with atypical PMR-like syndromes, there is significant risk of cancer involving bones and joints. Isotopic bone scan is an appropriate screening test for such a possibility.