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[Multiple myeloma presenting with amyloid arthropathy]
Summary
Amyloid arthropathy, a rare complication of multiple myeloma (MM), can mimic rheumatoid arthritis. Early diagnosis is crucial to prevent fatal outcomes, as highlighted in an unusual MM case presenting with joint symptoms before cancer diagnosis.
Area of Science:
- Rheumatology
- Hematology
- Medical Imaging
Background:
- Amyloid arthropathy is an uncommon manifestation in patients with multiple myeloma (MM) or primary amyloidosis (PA).
- Joint infiltration by amyloid can present symptomatically for months, potentially delaying diagnosis and leading to fatal complications.
- Early recognition of amyloid arthropathy is critical for timely MM or PA management.
Observation:
- A 59-year-old woman presented with a four-month history of bilateral hand hypesthesia and polyarthralgia.
- Symmetrical joint swelling was observed in the shoulders, wrists, hips, and finger joints, with avid uptake on Tc-99m (V) DMSA scans.
- The patient exhibited advanced renal insufficiency and was on hemodialysis.
Findings:
- Serum and urine immunoelectrophoresis revealed an IgG-lambda M-component and lambda Bence Jones proteins, indicative of MM.
- Bone marrow biopsy and roentgenograms confirmed the diagnosis of multiple myeloma.
- Synovial membrane biopsy demonstrated amyloid deposition, confirming amyloid arthropathy.
Implications:
- This case underscores the importance of considering amyloid arthropathy in the differential diagnosis of polyarthralgia, especially in patients with renal insufficiency.
- Prompt diagnosis and treatment of amyloid arthropathy associated with MM can lead to significant clinical improvement.
- The findings highlight the potential for articular manifestations to precede the hematological diagnosis of multiple myeloma.