Neoplastic diseases are characterized by a diversity of structural, hematologic, metabolic, immunologic, and biochemical abnormalities producing a wide spectrum of associated symptoms. These features of neoplasm are frequently the target of a growing repertoire of cancer therapies that themselves are capable of producing both local and systemic tissue responses. The diversity of tissues impacted and range of clinical presentations of neoplasm and associated neoplastic therapy are rivaled by few other diseases with the exception of rheumatic disorders and it is therefore common that the differential diagnosis of an occult illness includes diseases from each of these categories. The range of pathophysiologic changes produced by neoplastic disease, neoplastic therapy, and rheumatic disorders is similar in that each can either promote or inhibit cellular proliferation, tissue necrosis and fibrosis, ischemia, or neovascularization and stimulate localized or systemic inflammation. It is therefore not surprising that these processes share not only clinical manifestations, but many laboratory features as well.
Epidemiologic studies of neoplastic and rheumatic disease go further by demonstrating an association between these disorders and support that the shared clinical and laboratory features are more than just chance. Neoplastic tissue can exert a range of influences on the immune system and this immune modulation appears to be just one of several ways in which neoplasm promotes manifestations of rheumatic disease. These findings reinforce the importance of considering neoplasm in patients presenting with the rheumatic symptoms and the value of recognizing the range of autoimmune phenomenon that can develop in the setting of neoplasms and neoplastic therapy.
This issue of Rheumatic Disease Clinics of North America is devoted to exploring the rheumatic manifestations of neoplastic disease and associated therapies. The articles are structured to provide an overview of the association between primary rheumatologic and neoplastic disease followed by an in-depth organ system based discussion of rheumatic manifestations and laboratory features shared by rheumatologic disease, neoplasms, and neoplastic therapy. When possible, these reviews highlight characteristics that help guide the physician in differentiating primary rheumatologic conditions from those secondary to neoplasm and/or neoplastic therapy and in doing so highlight the need for clinical vigilance.
These articles are the work of many talented individuals with expertise across the spectrum of topics including oncology, oncologic-based chemotherapy and radiation therapy, rheumatology, dermatology, and immunology. We would like to thank the contributing authors for their hard work and Elsevier Publishing, Oregon Health & Sciences University, and the Portland VA Medical Center for the continued support.