ARTRITIS U SKLOPU PARANEOPLASTIČNOG SINDROMA – PUT DO RANE DIJAGNOZE NEOPLAZME? – PRIKAZ BOLESNIKA

Marija Glasnović, Dražen Bedeković, Ivica Bošnjak, Aleksandar Včev, Marija Jelić

Paraneoplastic syndrome is defi ned by clinical, radiological, and biological features associated with malignant disease without direct tumor invasion. The aim of our study was to present clinical and laboratory features of six cases of paraneoplastic arthritis, witch can help to establish early cancer diagnosis, and help to distinguish paraneoplastic arthritis from other rheumatic diseases. According to our case analysis, pareneoplastic arthritis has occurred in both sex equally, all patients were older than 45 years, in most of cases it occurred within 14 months before cancer diagnosis, usually in early stage of cancer. Clinical features of paraneoplastic arthritis were: symmetric poliarthritis, usually were affected small hand joints and knees, predominant acute onset, and rheumatic nodes weren’t present. Laboratory tests showed: high inflammatory markers (C-reactive protein, and erythrocyte sedimentation level), negative rheumatoid factor, and negative anti-citrullinated protein antibody. X-ray scan did not show signs of joint destruction. Long term remission of paraneoplastic arthritis was achieved by treatment of cancer.

Paraneoplastični sindrom je definiran putem kliničkih, radioloških ili bioloških obilježja povezanih sa zloćudnom bolesti bez izravne tumorske  nvazije. Cilj rada bio je prikazati šest bolesnika s paraneoplastičnim artritisom i evaluacija kliničkih i laboratorijskih obilježja kod naših bolesnika u svrhu postavljanja rane dijagnoze neoplastične bolesti i razlikovanja od ostalih reumatskih bolesti. Na temelju analize naših bolesnika možemo zaključiti da se paraneoplastični artritis javlja kod oba spola podjednako, u osoba starijih od 45 godina, kod većine unutar 14 mjeseci prije postavljanja dijagnoze neoplazme, obično u ranoj fazi neoplastične bolesti. Klinički daje sliku simetričnog poliartritisa s najčešće zahvaćenim malim zglobovima šaka i koljenima, obično akutnog početka simptoma, odsutnosti reumatskih čvorova, nazočnih visokih vrijednosti upalnih markera - CRP i SE, negativnog reumatoidnog faktora i anticitrulinskih protutijela, odsutne radiološke potvrde destrukcije zahvaćenih zglobova i karakteristično je postizanje trajne remisije artritisa liječenjem neoplastične bolesti.