Polymyalgia rheumatica and chronic lymphatic leukaemia
J von Knorring, O Selroos
PMID: 929120 DOI: 10.3109/03009747709095438
Abstract
A patient with polymyalgia rheumatica (PMR) is reported in whom, at the time of diagnosis, the number of lymphocytes in peripheral blood and bone marrow was normal. Lymphocytic infiltration typical of PMR was detected in renal and muscle biopsy specimens, and a liver fine-needle aspirate contained an abnormal lymphocytic infiltration, probably leukaemic. The number of lymphocytes gradually increased in bone marrow and peripheral blood until, almost 5 years after PMR had been diagnosed, a typical picture of chronic lymphatic leukaemia (CLL) was observable. The significance of the reported combination is discussed. The possibility is pointed out that a CLL in progress must be suspected when persistent lymphocytosis occurs in a patient with typical PMR, even if initially the response to treatment with corticosteroids suggests that PMR is the sole disorder.
This is very interesting as something similar is happening to me now!! my lymphocytes and reticulocytes show increasingly abnormal blood results, rheumatologist referred me for an urgent PET/CT scan which showed diffuse bone marrow infiltration she said there could be any number of reasons for this and wouldn't commit to what until she had referred me to haematology, I'm currently awaiting the outcome of their referral from the Lymphoma multi disciplinary team (mdt) meeting, it's a little concerning as everything seems to have slowed down again due to covid and next rheumatology appointment isn't until 11th Feb. I was originally diagnosed with pmr in April 2019 & gca April 2020 but scan shows vasculitis under control due to steroids according to my rheumatologist, currently on 17.5mg pred and wondering just what really is wrong with me!! I've had problems with large red blood cells before and my gp didn't seem concerned it was the rheumatologist who started looking into my blood results and she is concerned!!!
I am interested in these posts about pmr linked to leukaemia. I have not noticed anything like this before on this forum. I was diagnosed with pmr in May 2018 and just recently in October 2020 with leukaemia (cml type) is there a connection? Not sure who to ask about this otherwise as GP does not seem to know.
I also have questions no one seems able to answer but I will keep asking and find out what I can then post any relevant information good luck to you stay safe.
It is a fairly old case report (1977). I would hope that nowadays the haematology results would flag up something like that quite quickly. BUT that also depends on one's GP or rheumy being diligent and doing them! Which we know they often don't.
Interesting that they did muscle biopsies and found something they regarded as typical of PMR - haven't come across that before.
I think it is important to clarify the meaning of "linked".
There said by some to be an increase in rates of cancer diagnoses in the first 6 months or so after a PMR diagnosis has been made but that doesn't mean that PMR and leukaemia or any other cancer are linked. Correlation is not causation.There are a couple of potential reasons for this. One is that the symptoms we call PMR are not the disease itself, they are a set of symptoms that are caused by an underlying medical condition and there is quite a wide range including a few varieties of cancer. A diagnosis of PMR should be one of exclusion - all the other potential reasons should be checked for and when they are negative that increases the likelihood that it is PMR, for which there is no definitive test.
Another equally valid reason is that once we have gone to the doctor with PMR or GCA symptoms we are under closer medical supervision than we would be normally - and so a good doctor is doing blood tests on a regular basis that we wouldn't normally have. A surprisingly high number of cancer diagnoses are made in the ED - when a patient is there for something totally different and bloods or CT scan results pick up an abnormality that is investigated. That doesn't mean that tripping and hitting your head causes a brain tumour which was found when they were checking you didn't have a bleed. Nor does it mean the GP "missed" the diagnosis - usually the patients hadn't had any reason to go to the doctor.
The most likely cancer to be linked to PMR symptoms is a myeloma - which should be picked up with blood tests.
And a very relaible source says under differential diagnosis:
"Malignancy – Though there are rare anecdotes of malignancy presenting with muscle and joint pains that resemble PMR [48], the overall risk of malignancy in PMR is not increased. Contradictory findings have been reported from earlier studies, which identified no such risk, on the one hand, and subsequent studies based on large administrative data sets, which suggested an excess malignancy risk in the first 6 to 12 months after the diagnosis, on the other [61-63]. A population-based cohort study, however, found no difference in the cumulative risk of malignancy after 10 years of follow-up in patients with PMR compared with comparator subjects [64]. A malignancy workup is thus not required for a patient with an uncomplicated presentation of PMR. The presence of atypical clinical features (eg, fever, adenopathy, pulmonary infiltrate), however, must be carefully assessed before a diagnosis of PMR can be endorsed."
Hi, Very interesting. My lymphocytes increase as my preds dosage decreases. I have seen a haematologist who says I should have at least 10 years before it creates too much of a problem. He suggested special blood test for it every 12 months so we can keep on top of it. There is still so much to learn both side effects and medications for this horrible disease
Interesting! I'm the other way round - diagnosed with CLL two years ago and then PMR in August this year. I'm a little bit horrified that "at the time of diagnosis" of PMR, the poor person had had liver, kidney, muscle and bone marrow biopsies!! Thats a hell of a work-up for PMR.My thought is that PMR is fairly common, and by chance will therefore coincide with all sorts of other diagnoses that are found by accident because suddenly blood tests are being done.
Content on HealthUnlocked does not replace the relationship between you and doctors or other healthcare professionals nor the advice you receive from them.
Never delay seeking advice or dialling emergency services because of something that you have read on HealthUnlocked.
Polymyalgia Rheumatica [PMR] and Wobbly Legs
My journey with Polymyalgia Rheumatica 
Biologics to treat PMR
