Nonsecretory IgD-kappa multiple myeloma in a patient with Gaucher's disease.

A patient with Gaucher's disease and non-secretory multiple myeloma is described. The presence of typical Gaucher and myeloma cells was confirmed by transmission and scanning electron microscopy. The immunological studies established the diagnosis of 'non-secretory' type of multiple myeloma.     

Amyloid arthritis simulating rheumatoid disease in five patients with multiple myeloma

Five patients with multiple myeloma, three of whom had kappa light chain disease, presented with a symmetrical polyarthritis simulating rheumatoid arthritis. In all instances amyloid infiltration of synovial tissues appeared to account for the articular manifestations. Synovial fluids examined in four of these cases lacked the inflammatory characteristics of rheumatoid synovial fluid and three of them contained M components. In the course of synovial fluid analysis, small fragments of amyloid-containing material were detected in the aspirates from three of the patients, thereby establishing the diagnosis prior to confirmation by tissue biopsy. In the past patients with verified amyloidosis involving synovial tissues have been erroneously considered to have rheumatoid arthritis.     

Amyloid arthropathy in the course of multiple myeloma

OBJECTIVE: Primary amyloidosis is classical in the course of multiple myeloma (MM), but peripheral amyloid arthropathy is unusual. We evaluated the frequency and effect of amyloid arthropathy in a single center series of patients with MM. METHODS: Retrospective analysis of cases of peripheral joint amyloidosis in a cohort of patients with MM. RESULTS: Between 1978 and 1996, 11 patients (6 women, 5 men, mean age 59 yrs) were diagnosed with biopsy proven amyloid arthropathy in a cohort of 311 patients with MM. Arthritis was the first symptom of amyloidosis in all patients and occurred within the 6 months after MM diagnosis in most patients (7/11). Nine patients had light chain MM and X light chain was more common than kappa (6 vs 5). Shoulder hypertrophic arthropathy and rheumatoid arthritis-like polyarthritis were the 2 most common involved sites. In most cases, joint involvement was responsible for major limitations in activities of daily living. Amyloid deposits were clearly visible on magnetic resonance images (MRI), which also showed inflammatory synovitis in some cases. Control of MM was often associated with improvement of amyloid arthropathy, but additional rheumatological treatment--oral low dose prednisone or joint steroid injection--was often needed to achieve more complete relief. Amyloid arthropathy was not associated with decreased survival, except for patients with concomitant cardiac involvement. CONCLUSION: This series provides reliable information on amyloid arthropathy, especially regarding functional effects, anatomical lesions on MRI, and therapeutic options.     

Rheumatoid nodules indicating seronegative rheumatoid arthritis in a patient with gout

 The association of gout and rheumatoid arthritis is rare. We report the case of a patient with gout who presented with rheumatoid nodules indicating seronegative rheumatoid arthritis. Received: 29 July 2002 / Accepted: 4 November 2002     

Selective destruction of the calcified zone in a patient with seronegative rheumatoid arthritis

A 41-year-old woman with seronegative rheumatoid arthritis is presented. Three metatarsal heads showed a nearly selective destruction of the calcified zone of cartilage while other zones remained intact. The mechanisms underlying joint destruction are discussed.     

Erosive arthritis in a patient with amyloid arthropathy

Summary Amyloid arthropathy is said to be distinguished roentgenographically from rheumatoid arthritis by the absence of joint space narrowing and the absence of articular erosions. We present a patient with multiple myeloma with swelling, stiffness and firm synovial thickening of the wrists, metacarpophalangeal joints and proximal interphalangeal joints whose hand radiographs showed articular erosions of the carpal joints and ulnar styloid and joint space narrowing of the proximal interphalangeal joints and metacarpophalangeal joints. Synovial biopsy of the left wrist showed amyloid deposits with no inflammation. Previous reports of X-ray changes in amyloid arthropathy note preservation of joint spaces or widening. Erosions when noted are of non-articular bone rather than of the articular surface. This is the first case report of erosive articular disease in amyloid arthropathy.     

Early recurrence of rheumatoid arthritis after nonmyeloablative allogeneic blood stem cell transplantation in a patient with multiple myeloma

Allogeneic blood stem cell transplantation with reduced conditioning has been proposed as a new, potentially curative treatment option for patients with rheumatoid arthritis (RA). We report a 60-year-old woman with RA and coexisting multiple myeloma who was treated with high-dose melphalan and autologous blood stem cell transplantation (BSCT) followed by a nonmyeloablative allogeneic BSCT from her healthy dizygotic twin brother. She achieved a complete remission of her RA after autologous BSCT, but relapsed early despite complete donor chimerism following successful allogeneic transplantation with reduced intensity conditioning. This case illustrates that allogeneic BSCT following nonmyeloablative conditioning may be an uncertain option for curing patients with RA.     

Resorptive arthropathy in rheumatoid arthritis

Our survey was undertaken to determine the prevalence of resorptive arthropathy in rheumatoid arthritis (RA). A group of 256 patients with classical or definite RA were studied and resorptive arthropathy was noted in 13 (5.1%). The age and sex ratio of the patients with resorptive arthropathy was similar to the remainder of the patients, but the duration of RA was significantly greater (p = 0.003). Patients with resorptive arthropathy had severe radiographic changes. There was no significant difference in the prevalence of nodules, a positive rheumatoid factor or antinuclear factor and functional classification (American Rheumatism Association) in patients with resorptive arthropathy when compared to the remainder of the patients. Our study shows that, in a hospital based study of patients with RA, resorptive arthropathy may be commoner than generally recognized, and its prevalence may be similar to the findings in psoriatic arthritis.     

Pneumococcal septic arthritis of the knee in a patient with multiple myeloma

Although most patients with multiple myeloma are predisposed to pneumococcal infections, such infections usually involve the respiratory tract or the meninges. Pneumococcal arthritis is rare in the general population and is unexpectedly even rarer in patients with myeloma. We believe this to be the first case of pneumococcal septic arthritis of the knee in a patient with myeloma.     

Significance of rheumatoid factor isotypes in seronegative rheumatoid arthritis

Summary In a cross-sectional study of 124 patients with definite or classical rheumatoid arthritis (RA) and negative agglutination assays, rheumatoid factor (RF) isotypes were measured using an ELISA technique. Elevated levels of IgA-RF were found in 55 patients (44%), IgG-RF in 99 (80%), and IgM-RF in 20 (16%). The levels of IgA- and IgM-RF correlated with each other (P<0.001). Elevated levels of IgM-RF were associated with a more severe disease course. Elevated levels of IgA-RF correlated with the occurrence of bone erosions. The results of this study suggest that in patients with RA and negative agglutination assays, both IgM- and IgA-RF are markers of disease severity.     

Hand deformities resembling rheumatoid arthritis

Hand deformities that resembled to varying degrees those seen with rheumatoid arthritis were studied in 24 patients morphologically, functionally, and radiographically. In 22 patients no joint disease was present; in the remaining 2, x-rays were not characteristic of rheumatoid arthritis, and physical findings such as enormous soft-tissue swellings and marked finger clubbing plus paraarticular tenderness suggested nonarticular disease as the principal cause of their hand symptoms.Metabolic, vascular, pharmacologic, inflammatory, heritable, and neoplastic diseases were found as probable factors in the hand abnormalities. Unlike deformities of rheumatoid arthritis, which often do not respond well to available therapy, many hand abnormalities among our patients were treatable once the correct diagnosis was made.     

Synovial fluid in seronegative juvenile rheumatoid arthritis

Synovial fluid of 20 children with seronegative juvenile rheumatoid arthritis (JRA) and 20 patients with other joint pathology was examined for levels of total hemolytic complement and selected components, immune complexes, and α₂-macroglobulin (α₂-M). When adjusted for total protein, synovial levels of total hemolytic complement, C3, C4, and α₂-M did not differ significantly in the two groups. The concentrations of IgM and IgG were elevated in the JRA synovial fluid, but immune complexes were not increased when compared with the non-JRA group as determined by the Raji cell technique. α₂-M activity against substrates of C1 esterase was absent. Therefore, evidence of specific increase in immune complexes and complement activation was sought but not found, suggesting that they may not be a major factor in the pathogonesis of seronegative, pauciarticular JRA.     

Selective lymphocyte deficiency in seronegative rheumatoid arthritis

Prior studies have shown that in vitro infection with the Epstein Barr virus (EBV) is able to induce IgM rheumatoid factor production by normal lymphocytes, with a higher degree of production by seropositive rheumatoid arthritis lymphocytes. The present investigation demonstrates that EBV-infected lymphocytes from patients with seronegative rheumatoid arthritis produce in vitro significantly less IgM rheumatoid factor than do normal lymphocytes. The results suggest that the peripheral blood of seronegative patients is deficient in the rheumatoid factor precursor B cells responsive to stimulation by Epstein Barr virus.