Malignant disease is associated with a wide variety of musculoskeletal disorders and, importantly, may present as such. The arthropathy can result from the direct invasion of bone and joints by a primary tumour or metastases, or indirectly as a paraneoplastic syndrome. The latter group, which is the subject of the present review, can frequently be a source of confusion because of its extremely varied clinical presentation. Awareness that an underlying malignancy may produce certain musculoskeletal symptoms may allow earlier recognition of an otherwise occult, potentially curable malignancy.

The paraneoplastic arthropathies can be grouped into three broad categories: (i) paraneoplastic arthropathies of solid tumours; (ii) paraneoplastic arthropathies of haematological malignancies; and (iii) arthropathies associated with cancer immunotherapy. The clinical manifestation and possible mechanisms involved in the pathogenesis of these disorders are discussed.

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