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

Semin Arthritis Rheum. 2013 Dec;43(3):405-12. doi: 10.1016/j.semarthrit.2013.07.004. Epub 2013 Aug 28.

Abstract

Objective: Amyloid deposition in multiple myeloma (MM) may lead to an arthropathy resembling rheumatoid arthritis (RA). Since a systematic description of its natural history is lacking, we have performed a systematic analysis of all published cases.

Methods: Literature review featuring backward and forward database searches and direct inspection of reference lists. Inclusion criteria were as follows: publication between 1931 and 2012, diagnosis of multiple myeloma, and demonstration of light chain amyloid (AL) in any organ or in synovial fluid, arthritis, or synovitis.

Results: Overall, 101 cases were identified. Median age was 59 years and the male-to-female ratio was 1:1. A systemic manifestation of MM was reported in 88 cases. In 53 of these, characteristic physical findings (carpal tunnel syndrome, macroglossia, shoulder pad, and soft tissue swelling/masses) were present. Arthritis manifested before the diagnosis of MM in 63 cases, with 33 cases initially misdiagnosed as RA. There were 72 cases of poly-, 17 of oligo-, and three of monoarthritis. The shoulder joint was most commonly affected, followed by knees and small hand joints. Median synovial fluid leukocyte count was 2460 cells/mm(3), and was normal in seven cases. Synovial histopathology often featured mild synovitis without plasma cell infiltration. Imaging revealed articular or periarticular inflammation in many cases and bone lesions near 22% of affected joints. Treatments varied but led to some improvement in the majority of cases.

Conclusions: These results solidify previous experience that MM arthropathy tends to feature a symmetric RF-negative nonerosive polyarthritis. However, the results also highlight the diversity of its presentations and stress the importance of arthropathy as a potentially under-recognized presenting manifestation of MM.

Keywords: Amyloid; Arthritis; Arthropathy; Multiple myeloma.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Amyloidosis / complications*
  • Amyloidosis / pathology
  • Arthritis / complications*
  • Arthritis / pathology
  • Female
  • Humans
  • Joint Diseases / complications*
  • Joint Diseases / pathology
  • Joints / pathology
  • Male
  • Middle Aged
  • Multiple Myeloma / complications*
  • Multiple Myeloma / pathology
  • Synovitis / complications*
  • Synovitis / pathology