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

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.

journal_name

Semin Arthritis Rheum

journal_title

Seminars in arthritis and rheumatism

authors

Elsaman AM,Radwan AR,Akmatov MK,Della Beffa C,Walker A,Mayer CT,Dai L,Nativ S,Rygg M,Atsali E,Saijo K,Ogdie AR,Srinivasulu N,Fathi N,Schumacher HR,Pessler F

doi

10.1016/j.semarthrit.2013.07.004

subject

Has Abstract

pub_date

2013-12-01 00:00:00

pages

405-12

issue

eissn

0049-0172

issn

1532-866X

pii

S0049-0172(13)00152-2

journal_volume

pub_type

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