DIFFICULTIES IN DIAGNOSING SECONDARY ARTHROPATHY AND MAJOR CLINICAL SYNDROMES OF MYELOMA
Department of Internal Medicine № 3, Avicenna Tajik State Medical University, Dushanbe, Republic of Tajikistan
Objective: To study the difficulties in the diagnosis of secondary arthropathy and the major clinical syndromes of myeloma.
Methods: Fifteen patients with myeloma in age from 63 to 77 years old were examined: with a solitary form of myeloma – 3 people (group I) and 12 patients with multiple myeloma (MM) (group II). Residents of a village were nine, and the city – 6 people. Stage II of myeloma was noted in six cases, stage III – also in six observations.
Results: The following difficulties and errors in diagnosis were identified: the identity of the clinical symptoms peculiar to both myeloma and radiculopathy (66.6%), neuralgia (58.3%), rheumatic diseases (41.6%); insufficient clinical analysis of the information received (73.3%); under accounting of available research data (66.0%); incomplete clinical study of the patient (60.0%). In 25% of cases, patients were treated for severe anemia and in 16.6% of chronic renal failure without specifying the causal factors of the disease. Careful history collection and study of clinical symptoms showed that even before the appearance of bright symptoms were observed: fatigue (100%); rapid fatigability (100%); migrating bone pain (98%), the bones prone to buildup after changing the body position (100%). The main symptoms of the disease are bone pain and myeloma nephropathy, accompanied by protein pathology syndrome and hypercalcemia. As the progression of the disease was characterized by manifestations of visceral, hypercalcemic, hemorrhagic, intoxication and immunodeficiency syndromes. Bone changes in MM were radiographically, manifested by diffuse lesions of the bone tissue and the foci of the destruction of various more rounded shapes.
Conclusions: It is advisable to consider the following symptoms, suggestive of a possible myeloma: persistent polyarthralgia and any persistent neuro-radicular symptoms; normochromic anemia with a sharp acceleration of ESR, rapid progression and refractoriness to conventional antianemic therapy; pronounced proteinuria without extra renal symptoms. Consideration of clinical and laboratory parameters of the disease and X-ray signs of osteoarticular changes will contribute to earlier detection of myeloma and will reduce the incidence of complications.
Keywords: Myeloma, arthropathy, hypercalcemia, thrombocytopenia, Bens-Jones protein.
- San-Miguel JF. New tools for diagnosis and monitoring of multiple myeloma. Am Soc Clin Oncol Educ Book. 2013;10:12-5.
- Chesi M. Molecular pathogenesis of multiple myeloma: basic and clinical updates. Int J Hematol. 2013;3:13-23.
- Kachuri L, Demers A, Blair JJ, Spinelli M. Multiple pesticide exposures and the risk of multiple myeloma in Canadian men. Int J Cancer. 2013;8:46-58.
- Poddubnaya IV, Larionova VB, Babicheva LG. Infektsii u bol’nykh gemoblastozami [Infections in patients with hemoblastosis]. Prakticheskaya meditsina. 2009;5:379-401
- Markina YuYu. Porazheniya skeleta pri mielomnoy bolezni i ikh luchevaya diagnostika [Skeletal lesions in myeloma and their radiodiagnosis]. Sibirskiy meditsinskiy zhurnal. 2008;3(2):19-23.
- Mustafakulova NI, Melikova TI, Mustafakulova NA. Faktory riska razvitiya i osobennosti klinicheskogo techeniya leykemii v Respublike Tadzhikistan [Risk factors for development and features of the clinical course of leukemia in the Republic of Tajikistan]. Vestnik Avitsenny [Avicenna Bulletin]. 2015;1:67-71.
- Lendina IYu, Stoma IO, Iskrov IA, Uss AL, Karpov IA. Profilaktika i lechenie infektsionnykh oslozhneniy u patsientov s ostrym leykozom [Prevention and treatment of infectious complications in patients with acute leukemia]. Retsept. 2014;5:127-35.
- Chovdkhuri PR, Kryuchkov MI, Morozov SP, Zinina EA. Innovatsionnye metody diagnostiki mnozhestvennoy mielomy [Innovative methods for diagnosis of multiple myeloma]. Terapevticheskiy arkhiv. 2011;4:14-7.
- Markina YuYu. Osobennosti travmy pozvonochnika pri mielomnoy bolezni [Features of spine injury in myeloma]. Byulleten SO RAMN. 2008;5(133):138-41.
- Nazarova MV, Bein MA. Patologicheskiy perelom pozvonochnika v debyute mielomnoy bolezni [Pathological fracture of the spine in the onset of myeloma]. Vyatskiy meditsinskiy vestnik. 2012;4:30-2.
- Zvereva ON. Mnozhestvennaya mieloma u naseleniya Arkhangel’ska [Multiple myeloma in the population of Arkhangelsk]. Gematologiya i transfuziologiya. 2012;3:110-1.
- Fomina TV, Ostrovskiy TV, Verovskiy VE. Sravnitel’nyy analiz elektroforeticheskogo fraktsionirovaniya belkov syvorotki krovi v diagnostike [Comparative analysis of electrophoretic fractionation of blood serum proteins in diagnosis]. Klinicheskaya laboratornaya diagnostika. 2012;2:16-8.
- Koshy N, Ong MG, Nordberg ML, Turturro F, Cotelingam JD. Oligosecretory biclonal multiple myeloma. J La State Med Soc. 2013;165(4):215, 217-8.
- Kim SK, Jeong TD, Kim SY, Lee W. Characteristics of unexpected protein bands in multiple myeloma patients after autologous stem cell transplantation. Clin Biochem. 2014;25:13-5.
- Schmidt GP. Whole-body MR imaging of bone marrow. Eur J Radiol. 2015; 55(1):33-40.
- Durie BG. The role of anatomic and functional staging in myeloma: description of Durie. Eur J Cancer. 2013;42:1539-43.
- Rakhmatov MK, Odinaev FI, Odinaev ShF. Osobennosti epidemiologii leykemii u naseleniya Tadzhikistana v period 2000-2007 gg [Features of the epidemiology of leukemia in the population of Tajikistan in the period 2000- 2007]. Vestnik Avitsenny [Avicenna Bulletin]. 2008;4:63-7.
Mustafakulova Namuna Ibragimovna, Doctor of Medical Sciences, Associate Professor, Head of the Department of Internal Medicine № 3, Avicenna Tajik State Medical University
Kamolova Guldzhahon Negmatovna, Applicant for the Department of Internal Medicine № 3, Avicenna Tajik State Medical University
Address for correspondence:
Mustafakulova Namuna Ibragimovna
Doctor of Medical Sciences, Associate Professor, Head of the Department of Internal Medicine № 3, Avicenna Tajik State Medical University
734003, Republic of Tajikistan, Dushanbe, Rudaki Ave, 139
Tel.: +992 (918) 762494