Amyloid arthropathy associated with multiple myeloma: a systematic analysis of 101 reported cases
Ahmed M Elsaman1, Ahmed R Radwan, Manas K Akmatov
1Department of Rheumatology and Rehabilitation, Sohag University, Sohag, Egypt.
Objective:
Amyloid deposition in multiple myeloma (MM) may lead to an arthropathy resembling rheumatoid arthritis (RA). Since a systematic description of its natural history is lacking, we have performed a systematic analysis of all published cases.
Methods:
Literature review featuring backward and forward database searches and direct inspection of reference lists. Inclusion criteria were as follows: publication between 1931 and 2012, diagnosis of multiple myeloma, and demonstration of light chain amyloid (AL) in any organ or in synovial fluid, arthritis, or synovitis.
Results:
Overall, 101 cases were identified. Median age was 59 years and the male-to-female ratio was 1:1. A systemic manifestation of MM was reported in 88 cases. In 53 of these, characteristic physical findings (carpal tunnel syndrome, macroglossia, shoulder pad, and soft tissue swelling/masses) were present. Arthritis manifested before the diagnosis of MM in 63 cases, with 33 cases initially misdiagnosed as RA. There were 72 cases of poly-, 17 of oligo-, and three of monoarthritis. The shoulder joint was most commonly affected, followed by knees and small hand joints. Median synovial fluid leukocyte count was 2460 cells/mm(3), and was normal in seven cases. Synovial histopathology often featured mild synovitis without plasma cell infiltration. Imaging revealed articular or periarticular inflammation in many cases and bone lesions near 22% of affected joints. Treatments varied but led to some improvement in the majority of cases.
Conclusions:
These results solidify previous experience that MM arthropathy tends to feature a symmetric RF-negative nonerosive polyarthritis. However, the results also highlight the diversity of its presentations and stress the importance of arthropathy as a potentially under-recognized presenting manifestation of MM.
Insights
Multiple myeloma (MM) can cause joint pain and swelling that mimics rheumatoid arthritis (RA). This study analyzed 101 cases, highlighting MM arthropathy as a diverse and often under-recognized presenting symptom.
Area of Science:
- Rheumatology
- Hematology
- Medical Research
Background:
- Multiple myeloma (MM) can present with amyloid deposition, potentially leading to arthropathy that mimics rheumatoid arthritis (RA).
- A systematic description of the natural history of MM-associated arthropathy is lacking.
- This study systematically analyzes published cases to describe the characteristics and presentation of MM arthropathy.
Purpose of the Study:
- To systematically analyze published cases of multiple myeloma (MM) with associated arthropathy.
- To describe the natural history, clinical manifestations, and diagnostic features of MM arthropathy.
- To emphasize the importance of recognizing arthropathy as a potential presenting sign of MM.
Main Methods:
- Comprehensive literature review using backward and forward database searches and reference list inspection.
- Inclusion criteria: publication between 1931-2012, confirmed MM diagnosis, and evidence of light chain amyloid (AL) or arthritis/synovitis.
- Analysis of 101 identified cases, focusing on demographics, systemic MM manifestations, arthritis presentation, joint involvement, synovial fluid analysis, and imaging findings.
Main Results:
- 101 cases of MM arthropathy were identified, with a median age of 59 and a 1:1 male-to-female ratio.
- Arthritis preceded MM diagnosis in 63 cases, with 33 initially misdiagnosed as RA. The shoulder was the most commonly affected joint.
- Synovial histopathology often showed mild synovitis without plasma cell infiltration, and imaging revealed inflammation and bone lesions in a subset of cases.
Conclusions:
- MM arthropathy typically presents as a symmetric, rheumatoid factor-negative, nonerosive polyarthritis.
- The diverse clinical presentations underscore the need to consider arthropathy as a potentially under-recognized initial manifestation of MM.
- Early recognition of MM-associated arthropathy is crucial for timely diagnosis and management of multiple myeloma.
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