Unusual and memorable
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A 57 year old woman with metastatic ovarian carcinoma presented with painful, swollen, stiff, hands. Examination showed pronounced thickened palmar fascia and flexor tendons, with fixed flexion deformities of her fingers. Mild sclerodactly was noted and there was red, tender swelling of the MCP and PIP joints of both hands (figures 1 and 2). There was no history of Raynauds or dysphagia and no other skin or joint involvement.
Palmar fasciitis and arthritis syndrome was first described as a paraneoplastic phenomenon with ovarian carcinoma in 1982.1 It has also been described in association with other malignancies.2 Although clinically similar to reflex sympathetic dystrophy it is usually bilateral and rapidly progressive with extensive fasciitis and inflammatory arthritis. The rheumatic symptoms may precede detection of the tumour leading to misdiagnosis. Histopathological examination shows pronounced fibrosis with little mononuclear infiltrate. Chemotherapy may improve the arthritis.
| Figure Removed (Available Only in the Full Text) |
Contributors: GARY D WRIGHT, MICHAEL DOHERTY. Department of Rheumatology, City Hospital, Nottingham, NG5 1PB, United Kingdom.
References
| 1. | Medsger TA, Dixon JA, Garwood VF. Palmar fasciitis and polyarthritis associated with ovarian carcinoma. Ann Intern Med 1982;96:424-431. |
| 2. | Pfinsgraff J, Buckingham RB, Killian PJ, et al. Palmar fasciitis and arthritis with malignant neoplasms: a paraneoplastic syndrome. Semin Arthritis Rheum 1986;16:118-125[Medline]. |
© 1997 by Annals of the Rheumatic Diseases
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