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  • Isolated knee monoarthritis heralding resectable non-small-cell lung cancer. A paraneoplastic syndrome not previously described

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Isolated knee monoarthritis heralding resectable non-small-cell lung cancer. A paraneoplastic syndrome not previously described
  1. Fabrizio Cantini1,
  2. Laura Niccoli1,
  3. Carlotta Nannini1,
  4. Daniela Chindamo1,
  5. Michele Bertoni1,
  6. Emanuele Cassarà1,
  7. Carlo Salvarani2
  1. 1
    Hospital Misericordia a Dolce, Prato, 2nd Division of Medicine and Rheumatology Unit, Prato, Italy
  2. 2
    Division of Rheumatology, Hospital S. Maria Nuova, Reggio Emilia, Italy
  1. Dr Fabrizio Cantini, Hospital of Prato, 2nd Division of Medicine and Rheumatology Unit, Piazza Ospedale 1, 59100 Prato, Italy;fcantini{at}usl4.toscana.it

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

Results: Over 6 years, 6654 new outpatients with different rheumatic disorders were observed. Of these, 296 (4.4%) presented with isolated monoarthritis of the knee. In five out of 296 patients (1.7%) this feature represented the initial manifestation of NSCLC. All five patients were middle-aged men, with a long history of heavy cigarette smoking, who had a non-erosive, 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 five patients are in good condition after a median follow up of 41 months. The literature review revealed that paraneoplastic knee monoarthritis has not previously been reported.

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

https://doi.org/10.1136/ard.2007.075333

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    Footnotes

    • The corresponding author has the right to grant on behalf of all authors, and does grant on behalf of all authors an exclusive licence (or non-exclusive for government employees) on a worldwide basis to the BMJ Publishing Group Ltd to permit this article (if accepted) to be published in ARD and any other BMJPGL products and sublicences such use and exploit all subsidiary rights, as set out in our licence (http://ARD.bmj.com/ifora/licence.pdf).

    • Abbreviations:
      HOA
      Hypertrophic osteoarthropathy
      NSCLC
      non-small-cell lung cancer
      SCLC
      small-cell lung cancer