Reumatizam, Vol. 62 No. suppl. 1, 2015.
Review article
POLYMYALGIA RHEUMATICA, GIANT CELL ARTERITIS AND MALIGNANCY – IS THERE AN ASSOCIATION?
Daniela Marasković Krstulović
Ivona Božić
Katarina Borić
Abstract
Polymyalgia rheumatica (PMR) and giant cell arteritis
(GCA) are two common chronic inflammatory rheumatologic
disorders in adults aged over 50 years. These disorders
are closely related and commonly occur together. Classic
symptoms are bilateral pain, aching, and stiffness in the shoulders
and pelvic girdle, usually accompanied by elevated
inflammatory markers and anemia of chronic disease. The
hallmark of these two diseases is a good and quick response
to glucocorticoid therapy. An increased incidence of malignancy
has been observed in some autoimmune inflammatory
disorders. The mechanism of this association is poorly
understood, but is believed to be related to a dysregulation
of the immune system. Several case reports and case series
have suggested that an increased risk of malignancy also
exists in patients with GCA and PMR, but no clear association
has been proven due to conflicting data coming from
epidemiological studies. Recently, a few larger prospective
cohort studies were performed to explore this association.
An increased risk of a cancer diagnosis was found within the first 6-12 months after a PMR/GCA diagnosis. The data suggested
an excess of cancers of the genitourinary, lymphatic,
hematologic, and nervous systems. Beyond that period, the
risk of malignancy in PMR/GCA was only slightly elevated,
or even equal to the control population. As a diagnosis of
PMR and GCA is usually achieved “per exclusionem“, and
the clinical presentation is non-specific and may resemble
paraneoplastic syndrome, making an accurate diagnosis of
these disorders in the elderly population is essential. Clinicians
need to be aware of the possibility of alternative diagnoses,
including cancer. Thus, patients diagnosed with PMR
and GCA should be carefully monitored, especially in the
first year after the initial diagnosis, to exclude underlying
cancer. In up to 20% of cases of PMR/GCA the diagnosis is
subsequently revised to other inflammatory rheumatic disease
or malignant disease.
Keywords
polymyalgia rheumatica; giant cell arteritis; cancer; malignancy; paraneoplastic syndrome
Hrčak ID:
182790
URI
Publication date:
10.10.2015.
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