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Isolated knee monoarthritis heralding resectable non-small-cell lung cancer. A paraneoplastic syndrome not previously described.

Cantini F, Niccoli L, Nannini C, Chindamo D, Bertoni M, Cassarà E, Salvarani C

Hospital of Prato, 2nd Division of Medicine and Rheumatology Unit, Piazza Ospedale 1, 59100 Prato, Italy. fcantini@usl4.toscana.it

OBJECTIVE: To describe isolated knee monoarthritis as a paraneoplastic syndrome heralding non-small cell lung cancer (NSCLC), and to discuss its clinical characteristics. METHODS: Clinical records of all consecutive, new outpatients with isolated knee monoarthritis observed from January 2000 to December 2005 were reviewed. A systematic review of Medline and Cochrane Library databases was performed to identify English-language articles related to rheumatological paraneoplastic syndromes associated with NSCLC. RESULTS: Over 6 years, 6654 new outpatients with different rheumatic disorders were observed. Of these, 296 (4.4%) presented with isolated monoarthritis of the knee. In five out of 296 patients (1.7%) this feature represented the initial manifestation of NSCLC. All five patients were middle-aged men, with a long history of heavy cigarette smoking, who had a non-erosive, isolated knee monoarthritis, with mild articular fluid collection of non-inflammatory type. NSCLC was resectable in all patients, and knee monoarthritis remitted with no relapse confirming its paraneoplastic nature. All five patients are in good condition after a median follow up of 41 months. The literature review revealed that paraneoplastic knee monoarthritis has not previously been reported. CONCLUSION: Knee monoarthritis may in some cases represent a paraneoplastic syndrome heralding NSCLC at an early stage.

Published 13 November 2007 in Ann Rheum Dis, 66(12): 1672-4.
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