Carcinomatous polyarthritis is a rare paraneoplastic syndrome, To diagnose the carcinomatous polyarthritis, the patient should have some features suggesting the diagnosis. Ideally, one could confirm ti by removal of the tumor to see the
disappearance of
the polyarthritis.
Recently we experienced one patient with metastatic adenocarcinoma showing features of polyarthritis involving the multiple joints of upper and lower extremities. The 61 year-old female patient visited the local hospital for ulcerative wound on
the
lateral side of the ankle. The biopsy specimen showed metastatic adenocarcinoma. She was referred to our hospital for further diagnostic work up. When she was admitted, she complained of pain in left scapular area. Also she had pain and swelling
in
multiple joints involving proximal interphalangeal and metacarpophalangeal joins of hands, wrists, elbows, of both sides. The pain was developed abruptly 1 month prior to admission. She did not have morning stiffness. There was no family history
of
any
rheumatologic disorders. Bone scan showed hot uptake n left scapula and left distal tibia suggesting bony metastatic lesion. But there were also multiple diffuse uptake of the joints in which the patient complained of pain. Simple X-ray of both
hands
showed diffuse metacarpophalangeal joints space narrowing with periarticular soft tissue swelling, compatible with rheumatoid arthritis. The serum rheumatoid factor was negative, VDRL was non-reactive and antinuclear antibody was negative. We
examined
the synovial fluid and there was no malignant cells suggesting direct involvement of joint. We diagnosed the patient as carcinomatous polyarthritis. She did not want further work up for metastatic adenocarcinoma. For metastatic bony lesions, we
tried
palliative radiation therapy on the scapular and left distal tibia. For carcinomatous polyarthritis, we tried non-steroidal antinflammatory drugs. Also we tried some local measures including intraarticular steroid injection on left knee and
supraclavicular nerve block on left shoulder. Arthralgia was lessened and the joints swelling improved.
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