Patients with cancer frequently present with signs and symptoms of musculoskeletal and rheumatic diseases. Acute joint pain with swelling is the most common indication of an emergency rheumatologic evaluation. Individuals with monoarthritis should be evaluated immediately to rule out septic arthritis, as patients with cancer are at high risk for infection because of the immunosuppressive effects of their cancer and its treatment. Furthermore, use of empiric broad-spectrum antibiotics should be initiated to prevent loss of joint function. Acute crystal-induced arthritis—either gout or calcium pyrophosphate crystal deposition (CPPD) disease—is one of the most common causes of painful, swollen joints in patients with cancer and is often triggered by dehydration. Paraneoplastic syndromes can present as oligoarthritis or polyarthritis and are often diagnoses of exclusion. Other rheumatologic paraneoplastic syndromes, such as myositis, vasculitis, and tendinitis/fasciitis, can lead to significant morbidity. Skeletal complications may be caused by local or metastatic tumor invasion as well as pathologic and osteoporotic fractures and osteonecrosis and are usually associated with severe pain. In addition, cancer patients with pre-existing rheumatologic diseases can experience flare-ups of those diseases that require urgent intervention. All of these scenarios require physicians to be able to recognize the indications for emergency evaluation and treatment to prevent complications and ensure that patients continue to benefit from optimal cancer treatment.
KeywordsParaneoplastic syndrome Septic arthritis Crystal-induced arthritis Pyomyositis Musculoskeletal tumors Osteoporosis Osteoporotic fractures Vasculitis and vasculopathies Raynaud phenomenon Digital ischemia
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