In a report from Medscape, Karmela Kim Chan, MD, Assistant Professor of Medicine at Weill Cornell Medical College as well as an assistant attending physician at the Hospital for Special Surgery and the Memorial Sloan Kettering Cancer Center, argued for updated guidelines that rheumatologists can follow to screen their patients for cancer. Dr. Chan explained that certain rheumatic disease symptoms—including NXP2 or T1F1 gamma antibody positivity for patients with inflammatory myopathies; and high disease activity, chronic parotid gland swelling, cryoglobulins in the blood, and hypocomplementemia for patients with Sjögren’s syndrome—may be indicative of a malignancy. She also noted that patients with certain rheumatic conditions may be at higher risk for developing cancer, such as lung cancer and hematologic malignancies for patients with systemic sclerosis, lymphoma and lung cancer for those with rheumatoid arthritis, and lymphoma and cervical neoplasia for those with lupus.
Dr. Chan emphasized that paraneoplastic syndromes like remitting seronegative, symmetric synovitis with pitting edema; eosinophilic fasciitis; and palmar fasciitis with polyarthritis might mimic rheumatic diseases, possibly disguising the patients’ malignancies. Rheumatologists were advised to watch out for unusual disease behavior, notably explosive-onset polyarthritis among older patients or polymyalgia rheumatica among those with an atypical response to steroids. Additionally, Dr. Chan warned that antirheumatic medications have been known to increase the risk of developing malignancies. Patients taking cyclophosphamide have been found to be at greater risk of bladder cancer, myelodysplastic syndrome, and myeloproliferative disorders; those taking methotrexate or azathioprine were more susceptible to lymphoma and nonmelanoma skin cancers; and patients taking tofacitinib were potentially at greater risk of developing nonmelanoma skin cancers compared with those taking tumor necrosis factor inhibitors.
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