Abstract
Polymyalgia rheumatica (PMR) is considered the commonest inflammatory rheumatic disease in the elderly. The presence of constitutional symptoms such as fatigue, malaise, anorexia, weight loss and fever are common (in association with the typical PMR manifestations) and their association with very elevated inflammatory markers (for example erythrocyte sedimentation rate-ESR> 100 mm/hour or high C-reactive protein) may raise suspicion of a neoplasm. On the other hand, the relationship between PMR and cancer is still complex and data available from literature are contradictory. The association (or not) with giant-cell arteritis (GCA), the cumulative dosage of corticosteroids, the serum levels of C-reactive protein, the presence or not of RS3PE syndrome can represent important variables. In this review we perform a systematic electronic search of Medline and PubMed for evaluation of relationship between cancer and PMR, and present the more significant data.
Highlights
Polymyalgia Rheumatica (PMR) is considered the most frequent inflammatory rheumatic disease in the elderly [1,2,3]
In 2012, a European League Against Rheumatism/American College of Rheumatology collaborative initiative [5] have proposed new classification criteria for PMR in which the response to corticosteroid therapy has been replaced by the US evaluation of the scapular and pelvic girdle
A data-base study from Sweden examined 35,928 patients following hospitalization for PMR and/or giant-cell arteritis (GCA) in order to evaluated the overall and specific cancer risks and found a marginal increase in the incidence of cancer compared with the general population
Summary
Polymyalgia Rheumatica (PMR) is considered the most frequent inflammatory rheumatic disease in the elderly [1,2,3]. A subset of patients with PMR has swelling and pitting edema of the hands and feet due to tenosynovitis, so called remitting seronegative symmetrical synovitis with pitting edema syndromeRS3PE syndrome [7]: this association can be observed up to 10% of patients [8,9]. Constitutional symptoms such as fatigue, malaise, anorexia, weight loss and fever are common in PMR patients and their association with raised inflammatory markers can realize, in some cases, a diagnostic challenge with neoplasias [10]. The relationship between cancerogenesis and PMR is still complex and intricate, and the possibility that PMR can be a paraneoplastic syndrome [11] or may favor the onset of a tumor is still debated
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