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A 79-year old male was admitted to hospital for weight loss and polyarthritis. Examination revealed warmth, erythema and swelling of the left metacarpophalangeal joints, wrist, right shoulder and ankle. The CRP was elevated at 109 mg/L (ULN <5 mg/L) however other rheumatoid markers were within normal limits (ANA, RF, anti-CCP, ANCAs). Radiographs did not demonstrate joint erosions or other changes of inflammatory arthropathy. The patient was started on prednisone, celecoxib and opioids with minimal improvement in pain and function. Paraneoplastic arthritis was suspected.