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Is monoarthritis of the knee really a paraneoplastic syndrome?
- John P. Livoni MD, MPH (11 September 2007)
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John P. Livoni MD, MPH, Clinical Professor of Radiology University of California, Davis
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john.livoni{at}ucdmc.ucdavis.edu John P. Livoni MD, MPH
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Dear Editor, This is a response to the article by Cantini et al suggesting that monoarthritis of the knee may herald non small-cell lung cancer. The authors found that 1.7% of patients with monoarthritis of the knee were found to have non-small-cell lung cancer. All of their patients with lungcancer were middle-aged heavy smokers. I would like to point out that a number of studies (1,2) have measured the prevalence of asymptomatic lung cancer in similar populations of heavy smokers, presumably (though not specified) without monoarthritis. The data, from screening studies with chest x-rays or CT, indicate a lung cancer prevalence in the same range: somewhere between 1% and 2%. This suggests that the cancers found in patients with monoarthritis of the knee may be unrelated to the arthritis. It would be interesting to evaluate the 6000+ patients in the authors' Rheumatology Unit who did not have monoarthritis of the knee. Of those who did not, but who were middle-aged heavy smokers, the published data would suggest these patients have a similar rate of unsuspected lung cancer. References 1. Diederich, S. et al. Screening for Early Lung Cancer With low Dose Spiral CT: Prevalence in 817 asymptomatic Smokers. Radiology 2002;222:773-781. 2. Gohagan, J. et al. Baseline Findings of a Randomized Feasibility Trial of Lung Cancer Screening With Spiral CT Scan vs Chest Radiograph. Chest 2004;126:114-121. |
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