Metastatic cancer presenting as atypical polymyalgia rheumatica

A polymyalgia rheumatica (PMR) like syndrome is occasionally the first clinical expression of disseminated cancer, a presentation which has been mentioned but not well described. Patients admitted to the medical ward of a general hospital during a 12 year period were surveyed for the presence of PMR syndrome in the context of cancer. There were 4 males and 1 female, the ages ranged from 37 to 84 years (median 45 years). The onset of PMR preceded the diagnosis of cancer by 1 to 10 months (median 2 months). Systemic symptoms such as fever, sweats and malaise were present in all patients. One or several atypical features of PMR were noted: young age, only one typical site involved, asymmetrical involvement at typical sites, additional painful joints, and no improvement on 10 mg prednisone treatment. On X-ray no lytic lesions of bones were revealed. On scintigraphy pathological uptake was noted in the bones in all cases. Cancer was diagnosed for the first time at the index admission in 4 patients, while a prior carcinoma had relapsed in 1 patient. In conclusion, the PMR-like syndrome in patients with metastatic cancer to bones and joints differs from the common PMR by several atypical features. While a search for malignancy is not justified in patients presenting the typical PMR syndrome, according to the literature, evidence from the present survey suggests that there is a significant risk for bone involvement by cancer in patients who exhibit an atypical PMR.