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Clinical significance of antinuclear antibodies in malignant diseases: association with rheumatic and connective tissue paraneoplastic syndromes

Department of Internal Medicine, Vall d’Hebrón General Hospital, Barcelona, Spain, rsolans{at}hg.vhebron.es

C Pérez-Bocanegra

Department of Internal Medicine, Vall d’Hebrón General Hospital, Barcelona, Spain

A Salud-Salvia

Oncology Division, Vall d’Hebrón General Hospital, Barcelona, Spain

V Fonollosa-Plá

Department of Internal Medicine, Vall d’Hebrón General Hospital, Barcelona, Spain

M J Rodrigo

Biochemistry Department, Vall d’Hebrón General Hospital, Barcelona, Spain

L Armadans

Preventive Medicine, Vall d’Hebrón General Hospital, Barcelona 08035, Spain

C P Simeón-Aznar

Department of Internal Medicine, Vall d’Hebrón General Hospital, Barcelona, Spain

M Vilardell-Tarres

Department of Internal Medicine, Vall d’Hebrón General Hospital, Barcelona, Spain

Our objective was to determine the prevalence of antinuclear antibodies (ANAs) in patients with malignancies and to investigate if their presence might be related with development of musculoskeletal symptoms or paraneoplastic rheumatic syndromes. Antinuclear antibodies were determined by indirect immunofluorescenceon Hep-2 cells in 274 neoplasticpatients and in a control group of 140 age-adjusted healthy subjects. Antinuclear antibody specificities (anti-DNA and anti-ENA) were investigated in patients with rheumatological symptoms and positive ANA. Antinuclear antibodies were detected in 76 of 274 (27.7%) patients with malignancies and in nine of 140 (6.4%) healthy subjects. Twenty patients reported paraneoplasticrheumatic symptoms or syndromes. Two of them developedclinical symptoms mimicking rheumatoid arthritis (rheumatoid-likearthropathy), one systemic lupus erythematosus (lupus-like syndrome), one dermatomyositis and four cutaneous vasculitides. Musculoskeletal symptoms and paraneoplastic rheumatic symptoms and syndromes were both more frequently observed in patients with positive ANA. Antinuclear antibody specificities were found in only two cases. We can conclude that there is an increased incidence of antinuclear antibodies in malignant conditions. Musculoskeletal symptoms and rheumatic paraneoplastic symptoms and syndromes seem to be more frequent in patients with cancer-related positive ANAs. The failure to find ANA specificities (anti-ENA, anti-DNA) in patients with malignanciesand positive ANAs in our study may simply reflect molecular differences between the autoantigens involved in cancer and those characteristicallyinvolved in the systemic autoimmune diseases.

Key Words: antinuclear antibodies • malignancy • musculoskeletal symptoms • paraneoplastic syndromes

Lupus, Vol. 13, No. 3, 159-164 (2004)
DOI: 10.1191/0961203304lu521oa


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