ABSTRACT

Rheumatological differential diagnosis has been established in cases such as dry mouth, pain or swelling in the locomotor system, muscle weakness, fever, weight loss, Raynaud's phenomenon, lymphadenopathy, splenomegaly, skin stiffness and rash, which cannot be explained with an explicit reason. The idea that existing symptoms in a person with a clean oncological history may have been caused by disorganization of an occult cancer in the immune system is confusing for many clinicians. Rheumatologic complaints in a person with a history of cancer may be the primary tumor recurrence in the locomotor system, metastasis or a complication of previous treatment. Rapid increase in the size of the articular or periarticular structure in the follow-up, irregular boundary invasion of the surrounding structures, aggressive periosteal reaction and the presence of skin ulceration are the characteristics evoking malignancy. Radiotherapy, various chemotherapeutic agents and the rheumatic effects of hematological stem cell transplantation are worth mentioning. In patients whose medical histories do not indicate any malignancy, a newly developed local cancer, metastasis or paraneoplastic syndrome in the musculoskeletal system may present as a rheumatic disease. Rheumatic paraneoplastic syndrome is mainly characterized by carcinomatous polyarthritis, connective tissue diseases, Jaccoud's arthropathy, secondary Raynaud's phenomenon, vasculitis, palmar fasciitis and polyarthritis, hypertrophic osteoarthropathy, remitting seronegative symmetric synovitis and pitting edema, tumor-associated osteomalacia, reflex sympathetic dystrophy and eosinophilic fasciitis. One of the important issues to remember is that the current symptoms may have been due to a rheumatic disease associated with malignancy which is already present and has been unnoticed. Knowing that malignancy may be the underlying reason for rheumatic complaints through current knowledge and skepticism, the clinician may be able to make effective treatment of occult tumor with earlier diagnose. Therefore; if atypical symptoms occur rapidly and severely in patients over 50 years of age, the presence of malignancy should be ruled out before the primary rheumatologic diagnosis is established.