Management and Outcomes of Metastatic Disease to Intra-articular Synovium, Literature Review.

Abstract

Background: Intra-articular metastatic disease is a rare and unique manifestation of cancer metastasis, often originating from primary tumors such as lung adenocarcinoma, colorectal carcinoma, and malignant melanoma. The clinical symptoms frequently mimic chronic inflammatory arthritis, complicating diagnosis and treatment. This study aims to provide a comprehensive review of the incidence, clinical presentation, management strategies, and outcomes for patients with primary diagnosed cancers that metastasize to intra-articular locations, underscoring the specialized nature of this field.

Methods: We conducted a systematic search of PubMed, Medline, and Embase databases in July 2024, yielding 239 articles on intra-articular metastasis in cancer patients. Twenty-one studies met the inclusion criteria after screening. Five reviewers abstracted and analyzed data on patient demographics, metastatic details, diagnostic evidence, treatment modalities, and outcomes.

Results: The search yielded 239 articles, from which 21 studies met the inclusion criteria. The patient cohort is 24 cases with a mean age of 58.8 years. Of the 24 patients included, 18 (75%) were males and 6 (25%) were females. Colorectal carcinoma was the most frequent primary tumor (33.3%), followed by lung cancer (25%). The knees were predominantly affected by the metastases. Diagnostic modalities varied; magnetic resonance imaging, arthrocentesis, and biopsy were the most commonly used procedures. Treatment approaches were again varied and included chemotherapy, radiation therapy, and surgery in some instances.

Conclusion: Intra-articular metastases, though rare, present significant diagnostic and therapeutic challenges. The clinical manifestations often mimic inflammatory arthritis, complicating timely diagnosis. As underscored by this study, effective management requires a multidisciplinary approach tailored to the patient's primary cancer type and overall health status. This highlights the complexity of the disease and the need for collaborative care. Future research should focus on increasing awareness and early detection to improve patient outcomes.