[Analysis of the clinical picture and serologic profile in patients with dermatomyositis and polymyositis coexisting with neoplastic disease].

INTRODUCTION

There is much evidence on associations of dermatomyositis (DM) and polymyositis (PM) with malignant neoplasms. The prevalence of malignancies in patients with DM/PM is estimated at 6 to 60%. This study was undertaken to analyze the clinical and serologic picture of DM and PM coexisting with neoplastic disease.

MATERIAL AND

METHODS

We studied 61 patients (37 with PM, 16 with DM, and 8 with the overlap syndrome - OVS). Diagnostic imaging, endoscopy, electromyography, histopathology of skin and muscle biopsies, echocardiography, and biochemical tests were done in all patients. The profile of antinuclear antibodies (ANA), myositis-specific autoantibodies (MSA), and myositis-associated autoantibodies was determined as well. Correlations of neoplastic disease with clinical, laboratory, and serologic parameters in patients with DM or PM were studied with logistic regression analysis.

RESULTS

Neoplastic disease was diagnosed in eight patients (five with DM, two with PM, and one with OVS). Neoplastic disease was the cause of death in five patients. The mean time from diagnosis of DM/PM to diagnosis of tumor was 2.44 +/- 2.5 years. The most frequent clinical symptoms in patients with coexisting neoplastic disease were: dysphagia (8), myalgia (8), fever (7), skin lesions (5), pruritus (4), joint pain/effusion (4), and resistance to treatment (4). ANA were detected in six patients. None of the patients with a neoplasm tested MSA-positive; other antibodies were found in some patients. Risk factors for neoplastic disease included anemia at the time of diagnosis (OR: 16.75; 95% CI: 1.81-154.60; p = 0.013) and dysphagia (OR: 5.08; 95% CI: 1.23-243.90; p = 0.031).

CONCLUSION

Dysphagia and anemia at onset of the disease in a patient with idiopathic inflammatory myopathy are symptoms which suggest the risk of a tumor.