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[Paraneoplastic polymyalgia rheumatica. Case contribution]
Abstract:
Polymyalgia rheumatica (PMR) is an inflammatory disease which mainly affects the elderly and is highly responsive to steroid therapy. PMR can be associated with giant cell arteritis as well as with malignancy. Three cases of malignant neoplasms of the digestive apparatus beginning with a clinical picture similar to that of the "idiopathic" PMR, but with poor response to steroid therapy are presented. In one case the primary neoplasm was found only at the autopsy. These observations suggest that a careful clinical evaluation and a long follow-up are necessary for a correct diagnosis of "idiopathic" PMR.
Insights
Polymyalgia rheumatica (PMR) can mimic digestive cancers. Early cancer detection requires careful evaluation and long-term monitoring, especially when PMR symptoms do not respond to steroid treatment.
Area of Science:
- Rheumatology
- Gastroenterology
- Oncology
Background:
- Polymyalgia rheumatica (PMR) is an inflammatory condition primarily affecting the elderly.
- PMR typically shows high responsiveness to corticosteroid therapy.
- PMR can be associated with giant cell arteritis and underlying malignancy.
Observation:
- Three cases are presented where digestive system cancers initially mimicked idiopathic PMR.
- These neoplasms presented with symptoms similar to PMR but exhibited poor response to steroid treatment.
- In one case, the primary malignancy was only identified during autopsy.
Findings:
- Malignant neoplasms of the digestive apparatus can present with clinical features resembling polymyalgia rheumatica.
- A lack of response to steroid therapy in suspected PMR cases warrants further investigation for underlying malignancy.
- Digestive cancers may remain undiagnosed initially, even with PMR-like symptoms.
Implications:
- These findings underscore the importance of thorough clinical evaluation for patients presenting with PMR-like symptoms.
- Extended follow-up is crucial for accurate diagnosis, particularly in cases unresponsive to standard PMR treatment.
- Considering malignancy in the differential diagnosis of PMR is essential for timely and appropriate patient management.