Approach to paraneoplastic syndromes in rheumatology

Abstract

Background. Paraneoplastic syndromes (PNS) are distant effects of cancer not caused by direct tumor invasion or metastasis. In rheumatology, they often mimic autoimmune diseases, leading to diagnostic difficulties and therapeutic challenges due to overlapping symptoms and unclear clinical presentation. Objective(s). To review the clinical features, underlying mechanisms, and diagnostic approaches of paraneoplastic rheumatic syndromes, highlighting their role in early cancer detection. Materials and methods. This research analyzed bibliographic sources from PubMed, Google Scholar, Oxford Academic, and Medline, covering publications between 2014 and 2024. After filtering with keywords related to paraneoplastic syndromes, 16 relevant sources were included for this detailed review study. Results. Paraneoplastic rheumatic disorders (RDs) are diverse immune-mediated conditions linked to overt or occult malignancies. These include paraneoplastic arthritis, hypertrophic osteoarthropathy, amyloid arthropathy, vasculitis, dermatomyositis, polymyositis, scleroderma-like syndromes, and panniculitis-polyarthritis. They mimic autoimmune diseases but show atypical features such as acute onset in elderly, asymmetry, resistance to immunosuppressants, and rapid progression. Symptoms often precede cancer diagnosis, offering a crucial diagnostic window. Accurate diagnosis guides cancer detection and improves prognosis. Conclusion(s). Paraneoplastic rheumatic disorders serve as vital diagnostic clues to hidden malignancies. Early identification and prompt tumor-targeted treatment are crucial for successful management, since standard rheumatologic therapies frequently ineffective in controlling these paraneoplastic manifestations.