Letter to the editorAmyloid deposition in knee and ankle joints in the course of multiple myeloma
Introduction
Multiple myeloma (MM) is a malignant hematological disease, which is characterized by the production of monoclonal M protein and abnormal plasma cell infiltration of bone marrow and other tissues in some cases [1], [2]. MM is sometimes complicated by amyloidosis [3], [4]. Amyloidosis may be systemic or localized. Although the current classification of the disease is based on the biochemical composition of the precursor protein, unrelated to the biochemical features, clinical features are similar and may vary correlated with the involved tissue and organs. The most common symptoms are fatigue, weight loss, macroglossia, orthostatic hypotension, diarrhea, cardiomegaly, nephrotic syndrome, renal failure, congestive heart failure, carpal tunnel syndrome and neuropathy [4]. Amyloid infiltration in vital organs can be fatal if left untreated. Amyloid deposition in joints can be detected in the course of systemic myeloma complicating with the restriction of movements of infiltrated regions. Most common involved joints are shoulders, wrists, knees and metacarpophalangeal joints. Generally, arthropathy presents with bilateral symmetric polyarthritis. However, amyloid deposition in bilateral knees associated with other joint invasion has been reported very rarely [5]. We hereby present a case with the diagnosis of MM complicated with amyloid deposition in bilateral knee and ankle joints under the treatment.
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Case report
This fifty four years old male patient was referred to our hospital because of anemia, generalized bone pain and elevated erythrocyte sedimentation rate (ESR). He complained restriction in movements of bilateral wrist joints and diagnosed as carpal tunnel syndrome few months ago without further investigation and treatment. On his physical examination, there was no finding except pallor. Laboratory analysis showed anemia (haemoglobin as 7.9 g/dl), hyperuricemia (8.2 mg/dl) and elevated ESR (67
Discussion
Amyloid arthropathy is a rare complication of multiple myeloma. Although most cases of amyloid arthropathy are chronic hemodialysis patients related to elevated β2 microglobulin levels [5], there are case reports with amyloid arthropathy developed in the course of multiple myeloma or some reports with myeloma patient presenting with amyloid arthropathy. Most affected joints in the systemic amyloidosis were reported as shoulders and wrists, followed by the knees and metacarpophalangeal joints [6]
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Cited by (3)
Localised foot and ankle amyloid deposition
2018, Pathology Research and PracticeCitation Excerpt :Wild-type transthyretin, the amyloid protein found in age-associated (senile) amyloidosis, has been identified in localised amyloid deposits in articular and periarticular tissues of leg, knee, wrist and spinal joints [17–22]. Amyloid deposition has only previously been reported in ankle joint tissues in the context of (AL-associated) systemic and (beta-2 microglobin-associated) dialysis-related amyloidosis as well as (mutant transthyretin-associated) familial amyloid polyneuropathy [23–28]. In this investigation, we have sought to determine whether localised amyloid deposits occurs in foot and ankle (F&A) tissues and whether these deposits are age-associated and present in specific F&A lesions.
Multiple myeloma presenting with amyloid arthropathy as the first manifestation: Two case reports
2022, World Journal of Clinical Cases