Inflammatory low back pain–associated malignancies mimicking spondylarthritis

• Published in: Clinical rheumatology Vol. 43; no. 11; pp. 3345 - 3350
• Main Authors: Albayrak, Fatih, Kısacık, Bünyamin, Gündüz, İbrahim, Kudaş, Özlem, Koç, Emrah, Zengin, Orhan, Kutlu, Nagehan Dik, Gür, Mustafa, Küçük, Adem, Şen, Menice Güler, Ertaş, Şule Ketenci, Akar, Zeynel Abidin, Koca, Süleyman Serdar, Pehlivan, Yavuz
• Format: Journal Article
• Language: English
• Published: Cham Springer International Publishing 01-11-2024; Springer Nature B.V
• Subjects: Back pain; Bone cancer; Bone tumors; C-reactive protein; Colon cancer; Differential diagnosis; Erythrocyte sedimentation rate; Inflammation; L-Lactate dehydrogenase; Low back pain; Lung cancer; Lymphoma; Malignancy; Medicine; Medicine & Public Health; Metastases; Multiple myeloma; Original Article; Prostate cancer; Prostate carcinoma; Rheumatology; Sex ratio; Solid tumors; Tumors; Malignancy; Inflammatory low back pain; Solid tumors; Hematological malignancy; Spondylarthritis
• ISSN: 0770-3198; 1434-9949; 1434-9949
• DOI: 10.1007/s10067-024-07141-w

Objectives
Inflammatory low back pain (IBP) is a typical feature of spondylarthritis (SpA). IBP can be caused by infections, drugs, and different malignancies. Among cancers, hematologic malignancies and solid tumors can cause IBD either paraneoplastically or through metastasis. In this study, we aimed to present the demographic and clinical characteristics of our patients who presented with IBP in the last 10 years and whose final diagnosis was malignancy.
Methods
Thirty-four patients who presented with inflammatory low back pain in the last 10 years and were diagnosed with malignancy as the final diagnosis were included in the study. Thirty-six patients, diagnosed as axial SpA, with similar age-sex ratio of 1:1 from each center were included as the control group.
Results
Hematologic malignancies were multiple myeloma, acute leukemia, and lymphoma in descending order. Solid tumors were breast cancer, lung cancer, bone tumors, prostate, colon, embryonal carcinoma, and malignancy of unknown primary. In malignancy-related low back pain, the hematologic/solid ratio was similar (18/16), the interval between symptom and diagnosis was shorter, and biomarkers’ results such as erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and serum lactate dehydrogenase (LDH) levels were significantly higher than the control group.
Conclusion
Malignancy-related low back pain differs from SpA patients with a more severe clinical picture, higher acute phase reactants levels, and higher LDH values. Malignancies must be kept in mind in the differential diagnosis, and in order to validate our findings, the results of larger case series are needed, especially in terms of causative malignancies.
Key Points
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In malignancy-related inflammatory low back pain, the hematologic/solid ratio was similar, the interval between symptom and diagnosis was shorter, and acute phase reactant levels and LDH levels were significantly higher.
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Malignancy-related inflammatory low back pain differs from axial SpA patients with a more severe clinical picture, higher acute phase reactants levels, and higher LDH values.
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Malignancies must be kept in mind in the differential diagnosis of axial SpA.