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Case number 8

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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.

Acknowledgments

Contributors: gary d wright, michael doherty. Department of Rheumatology, City Hospital, Nottingham, NG5 1PB, United Kingdom.

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