Cancer and autoimmunity: autoimmune and rheumatic features in patients with malignancies.
OBJECTIVE
To review the autoimmune and rheumatic manifestations of patients with malignancy.


METHODS
A Medline search of all published papers using keywords related to malignancies, autoimmunity, rheumatic diseases, and paraneoplastic syndromes.


RESULTS
Patients with malignant diseases may develop autoimmune phenomena and rheumatic diseases as a result of (a) generation of autoantibodies against various autoantigens, including oncoproteins (P185, 1-myc, c-myc, c-myb), tumour suppression genes (P53), proliferation associated antigens (cyclin A, B1, D1, E; CENP-F; CDK, U3-RNP), onconeural antigens (Hu, Yo, Ri, Tr), cancer/testis antigens (MAGE, GAGE, BAGE, SSX, ESO, SCP, CT7), and rheumatic disease associated antigens (RNP, Sm). The clinical significance of the various autoantibodies is not clear. Anti-oncoprotein and anti-tumour suppression gene antigens are detected before the diagnosis of the cancer or in the early stages of the malignant disease, suggesting a potential diagnostic or prognostic role. Anti-onconeural antibodies are pathogenic and are associated with specific clinical neurological syndromes (anti-Hu syndrome and others). (b) Paraneoplastic syndromes, a wide range of clinical syndromes, including classic autoimmune rheumatic diseases that develop among patients with cancer. (c) Rheumatism after chemotherapy, a clinical entity characterised by the development of musculoskeletal symptoms after combination chemotherapy for malignancy.


CONCLUSIONS
Autoimmune and rheumatic features are not rare among patients with malignancies. They are the result of various diverse mechanisms and occasionally they may be associated with serious clinical entities.
Abu-Shakra
M
M
Department of Medicine and Rheumatic Diseases Unit, Soroka Medical Centre, and Ben-Gurion University, Beer-Sheva, Israel.
Buskila
D
D
Ehrenfeld
M
M
Conrad
K
K
Shoenfeld
Y
Y
D000974:Antibodies, Antinuclear / Q000276:immunology; D000951:Antigens, Neoplasm / Q000276:immunology; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects; D001323:Autoantibodies / Q000276:immunology*; D001327:Autoimmune Diseases / Q000209:etiology / Q000276:immunology*; D005260:Female; D019337:Hematologic Neoplasms / Q000188:drug therapy / Q000276:immunology; D006801:Humans; D007372:Interferons / Q000009:adverse effects; D008297:Male; D009369:Neoplasms / Q000188:drug therapy / Q000276:immunology*; D015513:Oncogene Proteins / Q000276:immunology; D010257:Paraneoplastic Syndromes / Q000188:drug therapy / Q000276:immunology*; D018809:Proliferating Cell Nuclear Antigen / Q000276:immunology; D012216:Rheumatic Diseases / Q000209:etiology / Q000276:immunology*
D000974:Antibodies, Antinuclear; D000951:Antigens, Neoplasm; D001323:Autoantibodies; D015513:Oncogene Proteins; D018809:Proliferating Cell Nuclear Antigen; D007372:Interferons