Thread by @rheum_cat

#ACR22 #ReviewCourse resuming with paraneoplastic syndromes in rheumatology

https://twitter.com/cappelliMD/status/1591126609926402049

This is not an iRAE talk but the main points at the outset highlight the need to understand how to talk with our oncology colleagues to best treat patients with malignancy and rheumatic disease

#ACR22 #ReviewCourse

RS3PE:

If no pitting edema of the hands, think if this is the right dx!

#ACR22 #CourseReview

Palmar fasciitis & polyarthritis (there's a Thieves Market poster on this!)

palmar skin: 🌴woody texture

if no cancer found: limited benefit with steroids, DMARDs 💊

#ACR22 #ReviewCourse

Pancreatitis Panniculitis Polyarthritis

🦵panniculitis looks like E nodosum & occurs in lower extremities

more a/w acute pancreatitis than pancreatic ca

💊tx resistant; pred starting dose 40mg

#ACR22 #ReviewCourse

Hypertrophic osteoarthropathy

🩻a/w lung cancer; HRCT if resp sxs

🩻clubbing (distal phalanges)
🦵periostitis (tibia, fibula); can see knee effusions

#ACR22 #Reviewcourse

Eosinophlic fasciitis

👉usually idiopathic rather than paraneoplastic but can be a/w hematologic disorders

🔍don't need peripheral or tissue eosinophilia to make a dx

#ACR22 #ReviewCourse

Fascial enhancement on MRI (STIR sequence) that resolves with MTX treatment

CK for the most part nml; aldolase may be ⬆️

💊Prednisone first line
💊MTX if refractory

#ACR22 #REviewcourse

LCV: typically limited to the skin (palpable purpura, ulceration)

Erythromelalgia: a/w heme malignancy.
🔥Pain can be excruciating & burning

#ACR22 #Reviewcourse

What about the strength of association with malignancy risk?

Why does it matter? Because it affects:

👉How concerned we should be that there is an underlying malignancy

👉How hard should we look for an underlying malignancy

#ACR22 #ReviewCourse