Rheumatic manifestations as initial presentation of malignancy: A case series from a tertiary care center in India

Abstract

Objective: Malignant neoplasms can be associated with a wide variety of rheumatological manifestations that may be caused by direct tumor invasion into bones and joints, as a paraneoplastic syndrome, and through altered immune surveillance. To identify the relationship between rheumaticmanifestations in various malignancies.Methods: Twenty patients with various malignancies presenting with rheumatic conditions in ourtertiary medical care were studied retrospectively from case records at the Kalinga Institute of MedicalSciences from 2013 to 2018.Results: In the present study, total of 20 patients including 12 males and 8 females with mean age atdiagnosis of was 46.3±22.2 years with various malignancy associated rheumatic diseases were included. In total 20% of patients with were current smokers. Seven (35%) had hematological malignancieswhereas 13 (65%) had solid malignancies. Most common presenting feature was arthritis (40%), followed by weight loss (20%), skin rash (10%), fever (15%) and muscle weakness (10%) at the time of diagnosis. All of them developed malignancy within 24 months of diagnosis. Among the autoantibodies, only 6 patients (30%) were positive for both ANA (n= 4, 20%) and RF (n=2, 10%), other antibodieswere negative. The patients in the hematological malignancies had significantly higher serum levelsof LDH, Mean±SD U/L compared to solid malignancy group (716.8±169.6 vs. 249.9±161.6, p