Which physical findings are characteristic of rheumatologic paraneoplastic syndromes?

Updated: Jan 12, 2021
  • Author: Luigi Santacroce, MD; Chief Editor: Wafik S El-Deiry, MD, PhD  more...
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Hypertrophic osteoarthropathy presents as digital clubbing and painful swelling of the hip, wrist, and knee, accompanied by an articular effusion. The long bones may also be involved; in such cases, patients complain of pain and x-rays show a typical elevation (thickening and detachment) of the periosteum

Polymyositis and dermatomyositis may occur as paraneoplastic syndromes in patients with lymphomas or cancers of the lung, stomach, breast, or uterus. [42] These syndromes are characterized clinically by asthenia, pain, and progressive hypertrophy of proximal muscles. Subsequent involvement of the skin manifests as violet-colored rashes of the face and hands.

A retrospective study by Fardet et al identified the following independent factors associated with an underlying malignancy in patients with dermatomyositis [43] :

  • Age at diagnosis >52 years (hazard ratio [HR], 7.24; 95% confidence interval [CI], 2.35-22.31)
  • Rapid onset of skin and/or muscular symptoms (HR, 3.11; 95% CI, 1.07-9.02)
  • Presence of skin necrosis (HR, 3.84; 95% CI, 1.00-14.85) or periungual erythema (HR, 3.93; 95% CI, 1.16-13.24)
  • A low baseline level of complement factor C4 (HR, 2.74; 95% CI, 1.11-6.75)
  • However, a low baseline lymphocyte count (< 1500/mm 3) was associated with a lower likelihood of malignancy (HR, 0.33; 95% CI, 0.14-0.80)

For patients with paraneoplastic scleroderma or SLE, the clinical picture is characteristic of nonparaneoplastic conditions

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