A STUDY OF AMYLOID ARTHROPATHY IN MULTIPLE-MYELOMA

  • 1 January 1981
    • journal article
    • research article
    • Vol. 50  (200) , 417-433
Abstract
Patients [43] with classical multiple myeloma were studied to assess the prevalence and characteristics of amyloid arthropathy using clinical, radiological and histological methods. Two patients had amyloid arthropathy and a 3rd case is described in detail. Complement and cryoprecipitate analysis of the synovial fluid and EM of the synovium, synovial debris and cartilage were undertaken to understand better the pathogenesis of what has been regarded as a rare complication of multiple myeloma. Complement components were not depressed and no evidence of a specific L chain containing immune complexes was found in synovial fluid cryoprecipitates. Histochemical and EM localization of amyloid in perichondrocyte lacunae as well as in synovial fluid debris, synovium and the articular cartilage surface suggest the possibility that chondrocytes and synovial macrophages may share a role in processing Ig components as a prelude to the formation of amyloid fibrils. Amyloid arthropathy occurs in .apprx. 5% of patients with multiple myeloma. The clinical picture can resemble rheumatoid arthritis with median nerve compression in the carpal tunnel and symmetrical arthritis of the wrists and small joints of the hands. Diagnosis can be established by examination of Congo red stained synovial fluid sediments under polarized light even in the absence of other clinical features of amyloidosis and when rectal biopsy is negative.