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Abstract
Polyarthritis is a common manifestation of rheumatologic disorders; however, paraneoplastic arthropathies also arise as polyarthritis or polymyalgia, particularly in patients with myelomas, lymphomas, acute leukemia, and solid tumors. Because paraneoplastic syndromes, in some instances, might be manifested before a cancer diagnosis, they are difficult to diagnose and are often misdiagnosed. We experienced a 63-year-old female patient who had nonspecific arthritis on both hands and feet accompanied by fever. She had been diagnosed as rheumatoid arthritis and treated with prednisolone and disease modifying antirheumatic drugs (DMARDs) including methotrexate and anti-tumor necrosis factor agents. Her arthritis did not respond with anti-rheumatic treatment and diffuse large B-cell lymphoma was diagnosed by bone marrow biopsy. After 6 cycles of chemotherapy, her arthritis was improved as well as underlying lymphoma.
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Figure 1.
Photographs of right hand showing polyarthritis at first visit (A) and improved arthritis after 6 cycles of rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) chemotherapy (B).
Figure 2.
T1-weighted magnetic resonance imaging of right hand at first visit (A) and after 6 cycles of rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) chemotherapy (B). Tenosynovitis of proximal interphalanges joints (white arrows) and bone erosions at carpal bones (black arrows) and metacarpophalanges joints (A) had been resolved after 6 cycles of R-CHOP chemotherapy (B).
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