Amyloid arthropathy in smoldering myeloma: Do not take it lightly
Eli Muchtar1, Rebecca L King2, Ellen D McPhail2
1Division of Hematology Mayo Clinic Rochester, MN, United States.
Abstract:
We report a case of smoldering multiple myeloma patient who developed signs and symptoms consistent with polyarthritis. A PET-CT demonstrated marked FDG activity in multiple joints, concerning for inflammatory arthritis. Arthrocentesis from the glenohumeral joint was consistent with inflammatory synovial fluid with no evidence for infection or crystals. Congo-red stain of the synovial fluid was positive, and mass-spectrometry based amyloid typing was consistent with wild-type transthyretin type. The patient responded instantly to glucocorticoids. This case reports highlights the feasibility of non-tissue diagnosis of amyloidosis using body fluids and underscores the importance of accurate typing to avoid erroneous treatment.
Insights
A smoldering multiple myeloma patient developed polyarthritis. Diagnosis of wild-type transthyretin amyloidosis was confirmed via synovial fluid analysis, enabling prompt glucocorticoid treatment.
Area of Science:
- Rheumatology
- Hematology
- Oncology
Background:
- Smoldering multiple myeloma (SMM) is an asymptomatic plasma cell disorder.
- Polyarthritis can be a rare manifestation of plasma cell dyscrasias.
- Amyloidosis, a complication of plasma cell disorders, can affect joints.
Observation:
- A patient with SMM presented with polyarthritis and joint FDG uptake on PET-CT.
- Synovial fluid analysis revealed inflammatory characteristics without infection or crystals.
- Congo-red staining of synovial fluid was positive for amyloid.
Findings:
- Mass spectrometry confirmed wild-type transthyretin amyloidosis in the synovial fluid.
- The patient experienced rapid symptom improvement with glucocorticoid therapy.
- This suggests non-tissue-based diagnosis of amyloidosis is feasible.
Implications:
- Highlights the utility of synovial fluid analysis for diagnosing amyloidosis in SMM patients.
- Emphasizes the importance of precise amyloid typing for appropriate treatment selection.
- Demonstrates the potential for early diagnosis and effective management of amyloid-related arthritis in SMM.
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