Monoclonal gammopathies presenting as inflammatory arthritis: uncommon but important – a case series

Srinivasulu, Nagaraj; Sharma, Vinod; Samant, Rohini

doi:10.1111/j.1756-185x.2012.01727.x

Cited by 7 publications

(5 citation statements)

References 12 publications

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“…Based on these findings, early detection of MG through regular laboratory work in patients with immune‐related conditions as underlying disease is important in establishing a treatment plan that can monitor progression from MGUS to MM and prevent end organ disease damage. A recent study showed that evaluation of plasma cell dyscrasia should be performed for any elderly patient with atypical arthritis and high disease activity . Therefore, we also suggest that MG should be ruled out for elderly patients with prolonged autoimmune diseases.…”

Section: Discussionmentioning

confidence: 85%

“…For example, the occurrence of monoclonal immunoglobulin is frequent in chronic inflammatory disorders such as chronic infection and autoimmune disorders . In particular, several recent reports on the close relationship between monoclonal gammopathy (MG) and Sjögren syndrome (SS) or inflammatory arthritis suggested that the link between MG and systemic autoimmune diseases requires greater attention . However, the association between MG and immune‐related conditions has not been fully investigated.…”

Section: Introductionmentioning

confidence: 99%

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A case series of autoimmune diseases accompanied by incidentally diagnosed monoclonal gammopathy: Is there a link between the two diseases?

et al. 2014

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A high prevalence of MG of undetermined significance (MGUS) has been noted in a series of patients with immune disorders, suggesting a possible association with MG. Further studies should focus on determining how MG relates to various clinical information and laboratory parameters, such as disease duration, disease activity and higher sedimentation rate. In the future, we also need to identify which stimuli, such as cytokine types and levels, can induce lymphocyte clonal transformation and the production of monoclonal antibodies.

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Section: Discussionmentioning

confidence: 85%

Section: Introductionmentioning

confidence: 99%

A case series of autoimmune diseases accompanied by incidentally diagnosed monoclonal gammopathy: Is there a link between the two diseases?

et al. 2014

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“…In fact, age greater than fifty years, bilateral eye involvement, and high ESR at presentation were suggestive of a diagnosis of AAION. However, a high ESR is a common laboratory finding in patients with serous monoclonal gammopathies [11], hence its specificity for the diagnosis of AAION may be scarce in these patients. CRP values, instead, were within the normal range in the present case, suggesting that CRP could be a more specific index of AAION in patients with coexisting plasma cell dyscrasias.…”

Section: Discussionmentioning

confidence: 99%

Light-chain amyloidosis mimicking giant cell arteritis in a bilateral anterior ischemic optic neuropathy case

et al. 2013

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BackgroundHerein we report a case of bilateral anterior ischemic optic neuropathy (AION) showing histopathologic evidence of AL-amyloidosis of the temporal arteries. It is known that light-chain (AL) amyloidosis may rarely affect the temporal arteries, mimicking giant cell arteritis, while, to our knowledge, the association between AL-amyloidosis and AION was not previously described.Case presentationA 64 year-old woman with AL-amyloidosis secondary to a monoclonal gammopathy of undetermined significance (MGUS) referred to our hospital for acute painless drop of vision due to bilateral AION. Age greater than 50 years, high erythrocyte sedimentation rate (ESR), and bilateral AION were suggestive of giant cell arteritis (GCA). However, a temporal artery biopsy excluded GCA, showing segmental stenosis of the lumen caused by amyloidosis of the artery wall.ConclusionsThe present case shows that AL-amyloidosis may present with AION, high ESR, and temporal artery involvement, mimicking GCA. In patients with monoclonal gammopathies, C-reactive protein may be a more specific index of GCA compared with the ESR. Patient medical history and pathology are crucial for a correct diagnosis.

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“…More recently, Srinivasulu et al reported a case series of 6 patients in 2012, 5 of which were seronegative for RF and anti-CCP antibodies and 1 was positive for both [ 6 ]. Two separate cases of MM presenting as inflammatory polyarthritis were reported by Fedric and Agarwal.…”

Section: Discussion and Literature Reviewmentioning

confidence: 99%

A Case of Multiple Myeloma Misdiagnosed as Seronegative Rheumatoid Arthritis and Review of Relevant Literature

Schoninger

Homsi

Kreps

et al. 2018

Case Reports in Rheumatology

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Multiple myeloma (MM) is a malignant plasma cell proliferation producing large numbers of monoclonal immunoglobulins. Typical MM symptoms include anemia, renal failure, hypercalcemia, and bone pain. Atypical symptoms have rarely been reported in the literature. We report a case of a 58-year-old male who presented with symmetrical inflammatory polyarthritis and was misdiagnosed with seronegative rheumatoid arthritis (RA). After failing many RA treatments and with further workup, the diagnosis of MM was made. This rare manifestation of MM carries a diagnostic challenge and causes a significant delay in treating such patients. Here, we report this unusual initial presentation with review of several cases in the English literature describing similar presentations.

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Monoclonal gammopathies presenting as inflammatory arthritis: uncommon but important – a case series

Abstract: Occurrence of inflammatory arthritis with plasma dyscrasias is more than a chance association. Plasma cell dyscrasias should be ruled out in any elderly patient presenting with atypical arthritis with disproportionately high ESR, high creatinine and hyperglobulinemia.

Cited by 7 publications

References 12 publications

A case series of autoimmune diseases accompanied by incidentally diagnosed monoclonal gammopathy: Is there a link between the two diseases?

A case series of autoimmune diseases accompanied by incidentally diagnosed monoclonal gammopathy: Is there a link between the two diseases?

Light-chain amyloidosis mimicking giant cell arteritis in a bilateral anterior ischemic optic neuropathy case

A Case of Multiple Myeloma Misdiagnosed as Seronegative Rheumatoid Arthritis and Review of Relevant Literature

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