Amyloid arthropathy associated with multiple myeloma: A systematic analysis of 101 reported cases

Elsaman, Ahmed M.; Radwan, Ahmed; Akmatov, Manas K.; Beffa, Cristina Della; Walker, Alisha; Mayer, Christian T.; Dai, Lie; Nativ, Simona; Rygg, Marite; Atsali, Erato; Saijo, Kaoru; Ogdie, Alexis; Srinivasulu, Nagaraj; Fathi, Nihal; Schumacher, H. Ralph; Peßler, Frank

doi:10.1016/j.semarthrit.2013.07.004

Cited by 36 publications

(54 citation statements)

References 18 publications

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“…However, strong points contradicting the diagnosis of RA with rheumatoid nodules were the absence of RF and lack of erosions or joint space narrowing in radiographs of hand and knee. Features that differentiate amyloid arthropathy from inflammatory arthritis include macroglossia, shoulder pad sign, hypercalcemia, urine Bence‐Jones protein and skeletal survey for lytic lesions . Our patient did not have macroglossia, shoulder fat pad sign or Bence‐Jones protein in urine.…”

Section: Discussionmentioning

confidence: 62%

“…Multiple myeloma with amyloid arthropathy has been described in various case reports and case series as a mimic of seronegative RA. 1,2,10 In a series of 101 patients of amyloid arthropathy with multiple myeloma, 63 had arthritis as the presenting manifestation, preceding the diagnosis of myeloma by 1-84 months; 33 were initially misdiagnosed as RA. Soft tissue swelling or nodules were documented in 32 patients.…”

Section: Discussionmentioning

confidence: 99%

“…Only one patient was RF positive and none were anti-cyclic citrullinated peptide antibody positive. 10 These patients were treated with standard cytotoxic drugs (such as vincristine, doxorubicin, lenalidomide and bortezomib) 11 and corticosteroids as used in the routine management of multiple myeloma and 80% of them had either good or moderate response in arthritis with the same. Additional therapies used in non-responders were NSAIDS, corticosteroid injections, radiosynovectomy and arthroplasty.…”

Section: Discussionmentioning

confidence: 99%

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Multiple myeloma masquerading as severe seropositive rheumatoid arthritis with subcutaneous nodules and mononeuritis multiplex

et al. 2016

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Multiple myeloma can rarely mimic seronegative rheumatoid arthritis (RA). We report a 55-year-old woman who presented with longstanding deforming polyarthritis with extensive subcutaneous nodules, tenosynovitis, anti-cyclic citrullinated peptide positivity and mononeuritis multiplex. Even though the clinical picture was consistent with seropositive RA, the absence of bone erosion or joint space narrowing on hand and knee radiographs led us to question the diagnosis of RA. Further investigation revealed a diagnosis of multiple myeloma with cutaneous amyloid deposits, based on serum immunofixation, bone marrow aspiration and biopsy of a subcutaneous nodule. The only clue to suspect myeloma from the basic investigations and clinical examination was mild hypercalcemia. This case serves to reiterate the need to maintain a heightened suspicion for other diagnoses even when RA appears most likely.

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Section: Discussionmentioning

confidence: 62%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Multiple myeloma masquerading as severe seropositive rheumatoid arthritis with subcutaneous nodules and mononeuritis multiplex

et al. 2016

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“…In this setting, treating the underlying hematologic malignancy is the most important intervention as patients tend to respond better to multiple myeloma treatment than to treatment of the amyloid arthropathy. Sensitivity of selected physical and laboratory findings for detecting amyloidosis in cases of multiple myeloma (MM) associated arthropathy has been illustrated in literature (Table 1) [5]. While our patient did not have arthropathy, she had bilateral carpal tunnel syndrome and hypogammaglobulinemia, which raised the suspicion of AL amyloidosis.…”

Section: Discussionmentioning

confidence: 63%

“…In our patient, dry eyes can likely be explained by the amyloid deposition in lacrimal glands, masquerading as Sjögren's syndrome [2]. AL amyloidosis associated with multiple myeloma may result in an arthropathy resembling RA [5]. In this setting, treating the underlying hematologic malignancy is the most important intervention as patients tend to respond better to multiple myeloma treatment than to treatment of the amyloid arthropathy.…”

Section: Discussionmentioning

confidence: 99%

Systemic Light Chain Amyloidosis Mimicking Rheumatic Disorders

Rao

Yong

Wasko

2016

Case Reports in Medicine

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Secondary amyloidosis can complicate chronic inflammatory autoimmune diseases. However, the clinical findings of primary amyloidosis may mimic those of primary rheumatologic disorders. We present the case of a 53-year-old woman who presented with dystrophic nail changes, dry eyes, bilateral carpal tunnel syndrome, Raynaud's phenomenon, and high titer positive nucleolar pattern antinuclear antibody. She was initially misdiagnosed as having Undifferentiated Connective Tissue Disease (UCTD). On further workup, she was eventually diagnosed with lambda light chain systemic amyloidosis by abdominal fat pad biopsy. Her symptoms completely resolved after autologous stem cell transplantation. With this case, we would like to highlight the similarities in the clinical features between light chain amyloidosis and rheumatological disorders. We would also like to emphasize the importance of the prompt recognition of the clinical features of amyloidosis which are crucial to triggering appropriate diagnostic procedures, since early diagnosis is a key to improving outcomes in this disease with an otherwise poor prognosis.

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Joint Pain and Proteinuria

Saleh

Sidiqi

Gertz

2019

JAMA

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A 66-year-old man with a history of bilateral carpal tunnel syndrome was evaluated for chronic joint pain and stiffness involving the shoulders, hips, and knees over the past 6 years. He had no fever, skin rash, headaches, vision changes, or urinary symptoms. He reported occasional bruising around his eyes. His only medication was acetaminophen as needed for pain. His vital signs were normal. No joint tenderness, warmth, or fluid collections were present, and skin examination was normal. The presence of raised soft tissue masses around the sternoclavicular joints (Figure, left panel) and scapulae (Figure, right panel) were noted. Laboratory evaluation revealed normal results for complete blood cell count, erythrocyte sedimentation rate (ESR), and levels of electrolytes, creatinine, and C-reactive protein. A spot urinalysis showed a protein level of 220 mg/dL (reference range, <26 mg/dL), and a 24-hour urine collection revealed 1.8 g of albumin (reference range, <229 mg/24 h). Magnetic resonance imaging (MRI) of the shoulders and hips showed synovial and capsular thickening.

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Amyloid arthropathy associated with multiple myeloma: A systematic analysis of 101 reported cases

Cited by 36 publications

References 18 publications

Multiple myeloma masquerading as severe seropositive rheumatoid arthritis with subcutaneous nodules and mononeuritis multiplex

Multiple myeloma masquerading as severe seropositive rheumatoid arthritis with subcutaneous nodules and mononeuritis multiplex

Systemic Light Chain Amyloidosis Mimicking Rheumatic Disorders

Joint Pain and Proteinuria

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