Anti-androgen treatment of prostatic carcinoma may be a risk factor for development of rheumatoid arthritis

There are many rheumatic paraneoplastic syndromes. The association between prostate carcinoma and subsequent development of rheumatoid arthritis (RA) has not been reported. We describe 3 cases of men developing inflammatory arthritis after anti-androgen manipulation for treatment of prostate carcinoma. None had diagnoses supporting other connective tissue disease or crystal arthritis. Only one patient had a weakly positive rheumatoid factor, and another had a positive antinuclear antibody. The cases fulfilled 1987 American College of Rheumatology criteria for RA. The onset of joint symptoms was within weeks to 9 months of starting therapy to suppress testosterone [2 received leuprolide acetate (Lupron) and one cyproterone acetate (Androcur)]. Review of the literature yielded no reports of prostate carcinoma associated with paraneoplastic RA. We review the literature with respect to associations of paraneoplastic RA and prostate carcinoma and discuss published data in the context of the hypothesis of lower testosterone and increased risk of RA.