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Isolated knee monoarthritis heralding resectable non small-cell lung cancer. A paraneoplastic syndrome not previously described.
  1. Fabrizio Cantini (fcantini{at}usl4.toscana.it)
  1. Hospital of Prato, Italy
    1. Laura Niccoli (lniccoli{at}usl4.toscana.it)
    1. Hospital of Prato, Italy
      1. Carlotta Nannini (tatta77{at}tiscali.it)
      1. Hospital of Prato, Italy
        1. Daniela Chindamo (dchindamo{at}usl4.toscana.it)
        1. Hospital of Prato, Italy
          1. Michele Bertoni (mbertoni{at}usl4.toscana.it)
          1. Hospital of Prato, Italy
            1. Emanuele Cassarà (ecassara{at}usl4.toscana.it)
            1. Hospital of Prato, Italy
              1. Carlo Salvarani (salvarani.carlo{at}asmn.re.it)
              1. Arcispedale S Maria Nuova, Italy

                Abstract

                Objective: To describe isolated knee monoarthritis as a paraneoplastic syndrome heralding non-small cell lung cancer (NSCLC), and to discuss its clinical characteristics.

                Methods: We reviewed the clinical records of all consecutive, new outpatients with isolated knee monoarthritis observed from January 2000 to December 2005. A systematic review of Medline and Cochrane Library databases was performed to identify English-language articles related to rheumatologic paraneoplastic syndromes associated with NSCLC.

                Results: Over 6 years, we observed 6654 new outpatients with different rheumatic disorders. Of these, 296 (4.4%) presented with isolated monoarthritis of the knee. In 5 out of 296 (1.7%) patients this feature represented the initial manifestation of NSCLC. All 5 patients were middle aged males, with a long history of heavy cigarette smoking, who had a nonerosive, isolated knee monoarthritis, with mild articular fluid collection of non inflammatory type. NSCLC was resectable in all patients, and knee monoarthritis remitted with no relapse confirming its paraneoplastic nature. All 5 patients are in good condition after a median follow up of 41 months. The literature review revealed that paraneoplastic knee monoarthritis has not been previously reported.

                Conclusion: Knee monoarthritis may represent in some cases a paraneoplastic syndrome heralding NSCLC in an early stage.

                • NSCLC early diagnosis
                • hypertrophic osteoarthropathy
                • knee monoarthritis
                • non small-cell lung cancer
                • rheumatic paraneoplastic syndromes

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