Rheumatic manifestations of lymphoproliferative disorders

Objective: The association between musculoskeletal features and lymphoproliferative disorders as well as the association of rheumatic diseases with an increased risk of malignancies is well-known. Methods: This paper describes three patients with inflammatory joint diseases treated with disease modifying antirheumatic drugs who developed lymphoproliferative disorders either of an abnormal type or with unusual clinical features. Results: The difficulty in differentiating the musculoskeletal symptoms of an underlying lymphoproliferative disease from the features of the rheumatic disease itself with special regard to treatment with disease-modifying antirheumatic drugs including biologics is emphasised on the example of patient 1. Patient 2 presented with a rare type of lymphoma and had been mistakenly diagnosed as having seronegative RA. The last patient with oligoarthritis represents an example of the sarcoidosis-lymphoma syndrome. Conclusion: This article addresses several of the problems rheumatologists may experience with the various rheumatologic manifestations of lymphoproliferative disorders. Until more definitive data are available, patients who develop unexpected arthritis should be considered for histologic biopsy to rule out coexistent neoplasia.