Rheumatological manifestations in patients with malignancies: Relation to immune modulation therapy

Abstract

Background: The relation between malignancies and rheumatic diseases (RDs) is complex with commonly shared symptoms. Rheumatological manifestations of malignancies may present as paraneoplastic syndromes and could follow chemotherapy. Aim of the work: to investigate rheumatic manifestations of patients with hematologic or solid malignancies and the relation to immune-modulation therapy. Patients and methods: The study included 25 patients with hematological and another 25 with solid malignancies. Patients were subjected to medical history, recording medications received, musculoskeletal examination and laboratory assessment. Results: The mean age and F:M of patients with hematological (43.7 ± 16.04 y and F:M 1.5:1) was significantly lower than those with solid (53.6 ± 14.3 y and F:M 7.3:1) malignancies (p = 0.025 and p = 0.024). Rheumatological manifestations as the first presentation was significantly higher in patients with haematological (60%) compared to solid (20%) malignancies (p = 0.004). Articular involvement was the commonest rheumatological manifestation (72%) followed by mucocutaneous (18%), oral/genital ulcers (10%), thromboembolic events (10%), Raynauds (8%), dry eyes (8%), myositis (6%) and myalgia (4%). The total leucocytic count and serum uric acid were significantly lower in patients with solid tumors (p = 0.045 and p = 0.026 respectively) and autoimmune markers were similar. Dry eye (16.7%), oral/genital ulcers (20.8%) and Raynaud‘s (16.7%) was present only in patients receiving anti-cancer treatment (n = 24). Paradoxically, arthritis was more frequent in those not receiving chemotherapy (n = 17) while myalgia (25%) was evident in those receiving checkpoint inhibitors (n = 8). Conclusion: Rheumatological manifestations occur with solid and hematological malignancies before or throughout the disease course and the most frequent was articular. Myalgia was associated with checkpoint inhibitors.