Musculoskeletal manifestations in patients with malignant disease |
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Authors: | Tamer A Gheita Yasser Ezzat Safaa Sayed Ghada El-Mardenly Waleed Hammam |
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Institution: | (1) Rheumatology Department, Cairo University, Cairo, Egypt;(2) Rheumatology Department, Al-Fayoum University, Al-Fayoum, Egypt;(3) Oncology Department, Cairo University, Cairo, Egypt |
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Abstract: | To detect and describe the incidence of musculoskeletal manifestations in different malignant diseases as well as their relation
to the treatment received whether by chemotherapy or radiation therapy. Sixty patients with different malignant diseases were
included in this study, 45 with solid tumors and 15 patients with hematological malignancy. The mean age was 46.55 ± 11.04 years
and the mean disease duration was 2 ± 0.75 years. The patients were fully examined for any rheumatologic involvement, laboratory
investigations were performed as well as dual energy X-ray absorptiometry study for bone densitometry. Treatment strategies
were assessed including the chemotherapeutics, radiation therapy, and/or surgery. Myalgias and arthralgias were the most frequent
followed by flexor tenosynovitis, frozen shoulder, and fibromyalgia syndrome. Hypertrophic osteoarthropathy was seen in five
patients, cutaneous vasculitis in two patients as well as arthritis. Osteonecrosis was present in one of the lunate carpal
bones of a patient with non-Hodgkin’s lymphoma (1.67%) and receiving high dose steroids. Rheumatoid factor was positive in
four patients, three of which had hepatitis C virus positivity and cryoglobulins. Anti-neutrophil cytoplasmic antibody was
negative in all the studied patients. The bone mineral density was significantly reduced in the patients with malignancy compared
to the control. Mild to moderate osteoporosis was present, being more evident in the spine and forearm. The bone loss was
higher in those with solid tumors and even more obvious in those receiving aromatase inhibitors. Musculoskeletal manifestations
occurring during malignancies and following the treatment represent a significant percentage of symptoms and signs which may
raise a clue to differential diagnosis. |
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