Ann Rheum Dis 2001;60:433-441 ( May )

Review

Cancer and autoimmunity: autoimmune and rheumatic features in patients with malignancies M Abu-Shakra^a, D Buskila^a, M Ehrenfeld^b, K Conrad^c, Y Shoenfeld^b

^a Department of Medicine and Rheumatic Diseases Unit, Soroka Medical Centre, and Ben-Gurion University, Beer-Sheva, Israel, ^b Research Centre of Autoimmune Diseases, Sheba Medical Centre, Tel-Hashomer, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel, ^c Institute for Immunology, Technical University of Dresden, Dresden, Germany

Correspondence to: Professor Y Shoenfeld, Department of Medicine B, Sheba Medical Centre, Tel-Hashomer, 52621 Israel Shoenfel{at}post.tau.ac.il

Accepted for publication 17 January 2001

OBJECTIVESTo review the autoimmune and rheumatic manifestations of patients with malignancy.
METHODSA Medline search of all published papers using keywords related to malignancies, autoimmunity, rheumatic diseases, and paraneoplastic syndromes.
RESULTSPatients with malignant diseases may develop autoimmune phenomena and rheumatic diseases as a result of (a) generation of autoantibodies against various autoantigens, including oncoproteins (P185, 1-myc, c-myc, c-myb), tumour suppression genes (P53), proliferation associated antigens (cyclin A, B1, D1, E; CENP-F; CDK, U3-RNP), onconeural antigens (Hu, Yo, Ri, Tr), cancer/testis antigens (MAGE, GAGE, BAGE, SSX, ESO, SCP, CT7), and rheumatic disease associated antigens (RNP, Sm). The clinical significance of the various autoantibodies is not clear. Anti-oncoprotein and anti-tumour suppression gene antigens are detected before the diagnosis of the cancer or in the early stages of the malignant disease, suggesting a potential diagnostic or prognostic role. Anti-onconeural antibodies are pathogenic and are associated with specific clinical neurological syndromes (anti-Hu syndrome and others). (b) Paraneoplastic syndromes, a wide range of clinical syndromes, including classic autoimmune rheumatic diseases that develop among patients with cancer. (c) Rheumatism after chemotherapy, a clinical entity characterised by the development of musculoskeletal symptoms after combination chemotherapy for malignancy.
CONCLUSIONAutoimmune and rheumatic features are not rare among patients with malignancies. They are the result of various diverse mechanisms and occasionally they may be associated with serious clinical entities.

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© 2001 by Annals of the Rheumatic Diseases
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