Molloy Catherine B, Peck Rahul A, Bonny Stephen J, Jowitt Simon N, Denton John, Freemont Anthony J, Ismail Abbas A
Rheumatology, St, Michaels Hospital, Toronto, Canada.
J Med Case Rep. 2007 Sep 10;1:84. doi: 10.1186/1752-1947-1-84.
Multiple myeloma can occasionally manifest with joint disease. We report the case of an individual with a progressive bilateral carpal syndrome and a symmetrical severe seronegative polyarthritis and joint swelling. Investigations revealed an erosive seronegative inflammatory arthritis in association with bilateral carpal tunnel syndrome, anaemia, hepatic impairment and nephrotic-range proteinuria. Synovial fluid cytology demonstrated plasmablasts and multinucleated cells with products of chondrolysis. The diagnosis of multiple myeloma (with secondary amyloidosis) was made on serum protein electrophoresis and bone marrow biopsy.The relationship between myeloma and joint disease is discussed, highlighted by the presence in this case of all three pathogenic features associated with arthritis in myeloma patients- an erosive arthritis, carpal tunnel syndrome and an invasive tumoural arthritis.
多发性骨髓瘤偶尔可表现为关节疾病。我们报告一例患有进行性双侧腕管综合征、对称性重度血清阴性多关节炎及关节肿胀的患者。检查发现为侵蚀性血清阴性炎性关节炎，伴有双侧腕管综合征、贫血、肝功能损害及肾病范围蛋白尿。滑膜液细胞学检查显示有浆母细胞和多核细胞以及软骨溶解产物。通过血清蛋白电泳和骨髓活检确诊为多发性骨髓瘤（伴继发性淀粉样变性）。本文讨论了骨髓瘤与关节疾病之间的关系，本病例中出现的骨髓瘤患者关节炎相关的所有三种致病特征——侵蚀性关节炎、腕管综合征及侵袭性肿瘤性关节炎，突出了这种关系。
