Abstract
Objectives
Inflammatory low back pain (IBP) is a typical feature of spondylarthritis (SpA). IBP can be caused by infections, drugs, and different malignancies. Among cancers, hematologic malignancies and solid tumors can cause IBD either paraneoplastically or through metastasis. In this study, we aimed to present the demographic and clinical characteristics of our patients who presented with IBP in the last 10 years and whose final diagnosis was malignancy.
Methods
Thirty-four patients who presented with inflammatory low back pain in the last 10 years and were diagnosed with malignancy as the final diagnosis were included in the study. Thirty-six patients, diagnosed as axial SpA, with similar age-sex ratio of 1:1 from each center were included as the control group.
Results
Hematologic malignancies were multiple myeloma, acute leukemia, and lymphoma in descending order. Solid tumors were breast cancer, lung cancer, bone tumors, prostate, colon, embryonal carcinoma, and malignancy of unknown primary. In malignancy-related low back pain, the hematologic/solid ratio was similar (18/16), the interval between symptom and diagnosis was shorter, and biomarkers’ results such as erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and serum lactate dehydrogenase (LDH) levels were significantly higher than the control group.
Conclusion
Malignancy-related low back pain differs from SpA patients with a more severe clinical picture, higher acute phase reactants levels, and higher LDH values. Malignancies must be kept in mind in the differential diagnosis, and in order to validate our findings, the results of larger case series are needed, especially in terms of causative malignancies.
Key Points • In malignancy-related inflammatory low back pain, the hematologic/solid ratio was similar, the interval between symptom and diagnosis was shorter, and acute phase reactant levels and LDH levels were significantly higher. • Malignancy-related inflammatory low back pain differs from axial SpA patients with a more severe clinical picture, higher acute phase reactants levels, and higher LDH values. • Malignancies must be kept in mind in the differential diagnosis of axial SpA. |
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Hoy D, Brooks P, Blyth F, Buchbinder R (2010) The epidemiology of low back pain. Best Pract Res Clin Rheumatol 24:769–781
Rudwaleit M, van der Heijde D, Khan MA et al (2004) How to diagnose axial spondylarthritis early. Ann Rheum Dis 63:535–543
Salvadorini G, Bandinelli F, DelleSedie A et al (2012) Ankylosing spondylitis: how diagnostic and therapeutic delay have changed over the last six decades. Clin Exp Rheumatol. 30(4):561–5
Rudwaleit M, van der Heijde D, Landewé R et al (2009) The development of Assessment of SpondyloArthritis international Society classification criteria for axial spondyloarthritis (part II): validation and final selection. Ann Rheum Dis 68(6):777–783
Kisacik B, Dag MS, Pehlivan Y et al (2014) Anti-cyclic citrullinated peptide (anti-CCP) antibodies with brucellosis. Rheumatol Int 34(6):873–874. https://doi.org/10.1007/s00296-013-2777-1
Alkan S, Kayiran N, Zengin O et al (2015) Isotretinoin-induced spondyloarthropathy-related symptoms: a prospective study. J Rheumatol 42(11):2106–2109. https://doi.org/10.3899/jrheum.150013
Sung H, Ferlay J, Siegel RL et al (2021) Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin 71(3):209–249. https://doi.org/10.3322/caac.21660
Wedam SB, Beaver JA, Amiri-Kordestani L et al (2018) US Food and Drug Administration pooled analysis to assess the impact of bone-only metastatic breast cancer on clinical trial outcomes and radiographic assessments. J Clin Oncol 36:1225
Van de Donk NWCJ, Pawlyn C, Yong KL (2021) Multiple myeloma. Lancet 397:410
Bianchi G, Campanacci L, Ronchetti M, Donati D (2016) Electrochemotherapy in the treatment of bone metastases: a phase II trial. World J. Surg. 40:3088–94
Campanacci L, Cevolani L, De Terlizzi F et al (2022) Electrochemotherapy is effective in the treatment of bone metastases. Curr Oncol 29:1672–1682
Naschitz JE, Yeshurun D, Rosner I (1995) Rheumatic manifestations of occult cancer. Cancer 75:2954–2958
Downie A, Williams CM, Henschke N et al (2013) Red flags to screen for malignancy and fracture in patients with low back pain: systematic review. BMJ 347:f7095. https://doi.org/10.1136/bmj.f7095
Henschke N, Williams C, Maher CG et al (2010) Red flags to screen for vertebral fracture in patients presenting with low-back pain. Cochrane Database of Systematic Reviews, Issue 8. https://doi.org/10.1002/14651858.cd008643.
Liu G, Hao Y, Yang Q, Deng S (2020) The association of fecal microbiota in ankylosing spondylitis cases with C-reactive protein and erythrocyte sedimentation rate. Mediators Inflamm 2020:8884324
Kısacık B, Albayrak F, Balcı MA et al (2023) Paraneoplastic arthritis: a series of 92 cases. Rheumatology (Oxford). Published online September 21, 2023. https://doi.org/10.1093/rheumatology/kead500.
Acknowledgements
Thanks to all the authors for their contributions.
Author information
Authors and Affiliations
Contributions
All the authors contributed equally to the conception and article design, acquisition, analysis, interpretation of the data, work drafting, and critical revision of the intellectual content. Additionally, the authors decided on the final version to be published and are responsible for all aspects of the work.
Corresponding author
Ethics declarations
Ethics approval and consent to participate
All studies were conducted according to the Declaration of Helsinki. Approval was obtained from the Ethics Committee of Fırat University. Ethics committee approval was received on 11.01.2024 as 21248 registration number. Study-related documents were reviewed and approved by independent ethics committees and institutional review boards. All patients provided written informed consent before participation in the study.
Disclosures
None.
Declaration of generative AI and AI-assisted technologies in the writing process
The authors did not use AI and AI-assisted technologies in the writing process.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.
About this article
Cite this article
Albayrak, F., Kısacık, B., Gündüz, İ. et al. Inflammatory low back pain–associated malignancies mimicking spondylarthritis. Clin Rheumatol (2024). https://doi.org/10.1007/s10067-024-07141-w
Received:
Revised:
Accepted:
Published:
DOI: https://doi.org/10.1007/s10067-024-07141-w