title: Report of anti-CCP antibody positive paraneoplastic polyarthritis and review of the literature.
abstract: A 45-year-old female presented to the rheumatology clinic with complaint of pain and swelling of multiple small joints of the hands and feet. She also complained of cough and shortness of breath onset around the same time. Since her cyclic citrullinated peptide antibody (anti-CCP) and rheumatoid factor tests were positive, rheumatoid arthritis (RA) was diagnosed and she was started on prednisone with plans for additional disease modifying therapy. Chest X-ray showed a small right pleural effusion. While additional pulmonary evaluation was being planned, a few weeks later she presented with dyspnea, fever and tachycardia. Spiral CT showed pulmonary emboli and increased pleural effusion and patient was started on anticoagulation. A chest tube was placed and exudative pleural effusion was drained. Cytology sample from bronchoscopy raised concerns for adenocarcinoma. Open lung biopsy confirmed moderately differentiated adenocarcinoma. The patient died of lung cancer in the hospital 8 weeks from her diagnosis of RA. We describe a case of paraneoplastic polyarthritis with positive anti-CCP antibody test which has not been reported before. We also review the literature on paraneoplastic arthritis which has been described in association with various other malignancies besides lung cancer.
authors.affiliation: Division of Rheumatology, Department of Internal Medicine, University of Missouri School of Medicine, CE 326, DC 043.00, 5 Hospital Drive, Columbia, MO 65212, USA. larsonec@health.missouri.edu
authors.forename: Emily
authors.initials: E
authors.lastname: Larson
authors.forename: Delene
authors.initials: D
authors.lastname: Etwaru
authors.forename: Chokkalingam
authors.initials: C
authors.lastname: Siva
authors.forename: Kenneth
authors.initials: K
authors.lastname: Lawlor
mesh_terms: D000230:Adenocarcinoma / Q000097:blood / Q000175:diagnosis* / Q000276:immunology; D000077192:Adenocarcinoma of Lung; D000906:Antibodies / Q000097:blood*; D018771:Arthralgia / Q000175:diagnosis; D001172:Arthritis, Rheumatoid / Q000097:blood / Q000175:diagnosis* / Q000276:immunology; D003371:Cough / Q000175:diagnosis; D004417:Dyspnea / Q000175:diagnosis; D017809:Fatal Outcome; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000097:blood / Q000175:diagnosis* / Q000276:immunology; D008875:Middle Aged; D010257:Paraneoplastic Syndromes / Q000097:blood / Q000175:diagnosis* / Q000276:immunology; D010456:Peptides, Cyclic / Q000276:immunology*; D016066:Pleural Effusion, Malignant / Q000000981:diagnostic imaging; D011859:Radiography; D012217:Rheumatoid Factor / Q000097:blood
chemical_list: D000906:Antibodies; D010456:Peptides, Cyclic; C487763:cyclic citrullinated peptide; D012217:Rheumatoid Factor