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[Multiple myeloma presenting with amyloid arthropathy]
Abstract:
Amyloid arthropathy rarely occurs in patients with multiple myeloma (MM) or primary amyloidosis (PA). Amyloid infiltration in and about the joints may be so extensive as to simulate the findings of rheumatoid arthritis. Some cases have been reported in which the articular manifestations were present for many months prior to the diagnosis of amyloid arthropathy. The delay of the diagnosis can result in the development of a fatal complication of MM or PA, which is not always unavoidable. We have encountered an unusual case of MM which the articular manifestations were present prior to the diagnosis of MM. A 59-year-old woman had a four-month history of hypesthesia in the median-nerve distribution of both hands and polyarthralgia. Far advanced renal insufficiency was evident, but its etiology was not determined. The patient was maintained on hemodialysis. The shoulders, wrists, hips and finger joints were symmetrically involved with articular swelling. All of these joints showed the avid uptake of Tc-99m (V) DMSA. The serum and urine immunoelectrophoresis demonstrated the presence of IgG-lambda type M-component and lambda type Bence Jones proteins, respectively. The bone marrow findings and bone roentgenograms supported the diagnosis of MM. Biopsy specimens from the synovial membrane revealed amyloid deposition. Her condition was much improved with melphalan and prednisolone.
Insights
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.