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Amyloid arthropathy in the course of multiple myeloma
Bruno Fautrel1, Jean-Paul Fermand, Jean Sibilia
1Rheumatology Institute, Hĵpital Cochin, Paris, France.
Objective:
Primary amyloidosis is classical in the course of multiple myeloma (MM), but peripheral amyloid arthropathy is unusual. We evaluated the frequency and effect of amyloid arthropathy in a single center series of patients with MM.
Methods:
Retrospective analysis of cases of peripheral joint amyloidosis in a cohort of patients with MM.
Results:
Between 1978 and 1996, 11 patients (6 women, 5 men, mean age 59 yrs) were diagnosed with biopsy proven amyloid arthropathy in a cohort of 311 patients with MM. Arthritis was the first symptom of amyloidosis in all patients and occurred within the 6 months after MM diagnosis in most patients (7/11). Nine patients had light chain MM and X light chain was more common than kappa (6 vs 5). Shoulder hypertrophic arthropathy and rheumatoid arthritis-like polyarthritis were the 2 most common involved sites. In most cases, joint involvement was responsible for major limitations in activities of daily living. Amyloid deposits were clearly visible on magnetic resonance images (MRI), which also showed inflammatory synovitis in some cases. Control of MM was often associated with improvement of amyloid arthropathy, but additional rheumatological treatment--oral low dose prednisone or joint steroid injection--was often needed to achieve more complete relief. Amyloid arthropathy was not associated with decreased survival, except for patients with concomitant cardiac involvement.
Conclusion:
This series provides reliable information on amyloid arthropathy, especially regarding functional effects, anatomical lesions on MRI, and therapeutic options.
Insights
Peripheral amyloid arthropathy is an unusual complication of multiple myeloma (MM). This study found it often presents as arthritis and impacts daily living, but can improve with MM treatment and targeted therapies.
Area of Science:
- Rheumatology
- Hematology
- Medical Imaging
Background:
- Primary amyloidosis is commonly associated with multiple myeloma (MM).
- Peripheral amyloid arthropathy is an uncommon manifestation of MM.
- Understanding its frequency and impact is crucial for patient management.
Purpose of the Study:
- To evaluate the frequency and clinical effects of amyloid arthropathy in patients with multiple myeloma.
- To describe the presentation, imaging findings, and treatment outcomes of this condition.
Main Methods:
- Retrospective analysis of patients diagnosed with biopsy-proven amyloid arthropathy within a cohort of multiple myeloma patients.
- Review of clinical data, imaging (MRI), and treatment responses.
Main Results:
- Eleven cases of amyloid arthropathy were identified in 311 MM patients.
- Arthritis was the initial symptom in all cases, often preceding or coinciding with MM diagnosis.
- Shoulder arthropathy and rheumatoid arthritis-like polyarthritis were common; MRI revealed amyloid deposits and synovitis.
- MM control and specific rheumatological treatments improved symptoms, with no survival impact unless cardiac involvement was present.
Conclusions:
- Amyloid arthropathy in MM presents significant functional limitations.
- MRI is valuable for diagnosing amyloid arthropathy and assessing joint inflammation.
- Therapeutic strategies involving MM control and targeted rheumatological treatments can alleviate symptoms.