J Rheum Dis.  2011 Mar;18(1):32-35. 10.4078/jrd.2011.18.1.32.

A Case of Paraneoplastic Syndrome Associated with Pancreatic Cancer Presenting as Rheumatoid Arthritis

• Kim YI
• Choi SG
• Lee HJ
• Lee KE
• Lee SJ
• Seo SR
• Kim TJ
• Park YW
• Lee SS

• KMID: 2223179
• DOI: http://doi.org/10.4078/jrd.2011.18.1.32

Abstract

Paraneoplastic cancer polyarthritis is a very rare manifestation of musculoskeletal disorders associated with several solid and hematologic malignancies. We describe a 71-year-old woman who presented initially with an abrupt onset of rheumatoid arthritis-like symmetrical polyarthritis. The patient was diagnosed with pancreatic cancer with multiple hepatic metastases approximately six months later. Her symptoms of polyarthritis improved after the introduction of medication including non-steroidal anti-inflammatory drugs and disease modifying anti-rheumatic drugs. This case suggests that a hidden malignancy should always be considered in elderly patients, who present with an abrupt onset of symmetric polyarthritis for the first time in their life.

Keyword

Paraneoplastic polyarthritis; Rheumatoid arthritis

MeSH Terms

Aged
Antirheumatic Agents
Arthritis
Arthritis, Rheumatoid
Female
Hematologic Neoplasms
Humans
Neoplasm Metastasis
Pancreatic Neoplasms
Paraneoplastic Syndromes
Antirheumatic Agents

Figure

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  Figure 1. Tc-99m HDP scan showing increased uptake in multiple joints including both wrists, right 2 nd to 5 th metacarpophalangeal joints, right 3 rd to 4 th proximal interpha-langeal joints, left 2 nd to 3 rd metacarpophalangeal joints, right shoulder, and left 1 st to 3 rd metatarso-phalangeal joints. The scan also showed a fracture in the right femoral neck.

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  Figure 2. Contrast-enhanced abdominal computed tomography showing multiple liver metastases (arrows) by the pancreatic head malignancy (arrowheads) invading the adjacent gastric wall, distal common bile duct and vessels.

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