Rheumatic masks of plasma cell dyscrasias

Objective: to consider clinical practice problems in the differential diagnosis of different types of plasma cell dyscrasias (PCD). Subjects and methods. Fourteen patients (8 men and 6 women) aged 52±12 years, in whom rheumatic diseases (RD) were ruled out and who were diagnosed as having primary PCD: different types of myeloma in 7 patients, myeloma + AL-amyloidosis in 2, AL-amyloidosis in 3, and Waldenstrom’s macroglobulinemia in 2, were examined. Results and discussion. The most common maldiagnosed RDs in patients with PCD were seronegative rheumatoid arthritis (RA), systemic lupus erythematosus, Sjogren’s disease, and different forms of vasculitis. The most frequent masks of RD were kidney (78%) and osteoarticular system (64%) lesions, vascular disorders (36%), peripheral polyneuropathies (36%), and enlarged salivary glands with xerostomia (28.5%). Serum and urine immunochemical study should be performed in all patients who have clinical manifestations of seropositive RA, spondyloarthritis, intensive bone pain syndrome, ulceronecrotic vasculitis, enlarged submandibular salivary glands with macroglossia in the absence of markers of autoimmune disease for the timely diagnosis of PCD and the exclusion of RD. The paper estimates the sensitivity and specificity of main methods used to diagnose different types of PCD.

plasma cell dyscrasias, multiple myeloma, solitary plasmacytoma, Bence-Jones myeloma, immunoglobulin light-chain amyloidosis, Waldenstrom’s macroglobulinemia, seronegative rheumatoid arthritis, systemic lupus erythematosus

1. <div><p>Kyle R. The monoclonal gammapathies. Clin Chem 1994;40:2154-61.</p><p>Андреева Н.Е., Чернохвостова Е.В. Иммуноглобулинопатии. М.: Медицина, 1985;240 с.</p><p>Goeken J., Keren D. Introduction the report of the consensus conference on monoclonal gammopathies. Arch Pathol Lab Med 1999;123:104-5.</p><p>Варламова Е.Ю. Иммунохимическая диагностика парапротеинемий. Клиническая онкогематология. Под ред М.А. Волкова. М.: Медицина, 2001;411-9.</p><p>Логвиненко О.А., Васильев В.И. Моноклональная секреция и болезнь Шёгрена. Тер арх 2006;12:85-91.</p><p>Логвиненко О.А., Васильев В.И. Ассоциации между болезнью Шёгрена и лимфомами. Науч-практич ревматол 2006;3:67-76.</p><p>Васильев В.И., Пробатова Н.А., Тупицин Н.Н. и др. Лимфопролиферативные заболевания при болезни Шёгрена. Онкогематология 2007;3:16-27.</p><p>Васильев В.И., Пробатова Н.А., Варламова Е.Ю. и др. Прогностическое значение смешанной моноклональной криоглобулинемии при болезни Шёгрена. Тер арх 2004;8:61-8.</p><p>Васильев В.И., Пробатова Н.А., Тупицин Н.Н. и др. MALT-лимфомы при болезни Шёгрена. Тер арх 2006;1:45-52.</p><p>Васильев В.И., Городецкий В.Р., Логвиненко О.А. и др. Дифференциальная диагностика плазматических дискразий в ревматологической практике. Совр ревматол 2010;4:16-24.</p><p>Osterland C. Monoclonal gammopathies - their identification and biological significance. Clin Chim Acta 1989;180:1-22.</p><p>Kyle R., Rajkumar S. Monoclonal gammopathies of undetermined significance. Best Pract Res Clin Haematol 2005;18:689-707.</p><p>Городецкий В.Р., Пробатова Н.А., Васильев В.И. и др. Первичная плазмоцитома лимфатических узлов. Гематол трансфузиол 2006;51(5):3-8.</p><p>Васильев В.И., Городецкий В.Р., Седышев С.Х. и др. Клинические проявления васкулита в дебюте множественной миеломы. Науч-практич ревматол 2010;1:81-7.</p><p>Brouet J.-C., Clauvel J.-P., Danon F. еt al. Biologic and clinical significance of cryoglobulins. Review. A report of 86 cases. Amer J Med 1974;57:775-87.</p><p>Naschitz J.E. Rheumatic syndromes: dues to occult neoplasia. Curr Opin Rheumatol 2001;13:62-6.</p><p>Blade J., Kyle R.A. Monoclonal gammopathies of undertermined significance. Myeloma. Biology and management. Eds J.S. Malpas, D.E. Bersagel, R.A. Kyle, K.S. Anderson. Oxford: Oxford medical publications, 1998;514—41.</p><p>Rajkumar S.V., Kyle R.A. (eds). Treatment of multiple myeloma and related disorders. New York: Cambridge University Press, 2009;1-195.</p><p>Smedby K.E., Baecklund E., Askling J. Malignant lymphomas in autoimmunity and inflammation: a review of risks, risk factors, and lymphoma characteristics. Review. Cancer Epidem Biomarkers Prev 2006;15(11):2069—77.</p><p>Zintzaras E., Voulgarelis M., Moutsopoulos H.M. The risk of lymphoma development in autoimmune diseases. A meta-analysis. Arch Intern Med 2005;165(14):2337-44.</p><p>Askling J., Bongartz T. Malignancy and biologic therapy in rheumatoid arthritis. Curr Opin Rheumatol 2008;20:334-9.</p><p>Kiltz U., Brandt J., Zochling J., Braun J. Rheumatic manifestations of lymphoproliferative disorders. Clin Exp Rheumat 2007;25:35-9.</p><p>Vital E.M., Emery P. Rheumatological manifestations of malignant haematological conditions. Reports on the rheumatic diseases series 5. Topical Reviews 2007;11:1-8.</p><p>Manganelli P., Fietta P., Quaini F. Hematologic manifestations of primary Sjogren’s syndrome. Clin Exp Rheumatol 2006;24:438-48.</p><p>Leandro M.J., Isenberg D.A. Rheumatic diseases and malignancy -is there an association? Scand J Rheumatol 2001;30:185-8.</p><p>Saadoun D., Sellam J., Ghillani-Dalbin P. et al. Increased risks of lymphoma and death among patients with non-hepatitis C virus -related mixed cryoglobulinemia. Arch Intern Med 2006;166(23):2101-8.</p><p>Kurzrock R., Cohen P.R. Vasculitis and cancer. Clin Dermatol 1993;11(1):175-87.</p><p>Васильев В.И., Седышев С.Х., Городецкий В.Р. и др. Сухой синдром как проявление AL-амилоидоза. Науч-практич ревматол 2011;5:92-7.</p><p>Андреева Н.Е., Балакирева Т.В. Множественная миелома. В кн.: Руководство по гематологии. Том 2. Под ред. А.И. Воробьева. М.: Ньюдиамед, 2003;151 —73.</p><p>Насонов Е.Л., Насонова В.А. (ред.). Национальное руководство по ревматологии. М.: ГЭОТАР-Медиа, 2008.</p><p>Gertz M.A., Comenzo R., Falk R.H. et al. Definition of organ involvement and treatment response in immunoglobulin light chain amyloidosis (AL): a consensus opinion from the 10th. International Symposium on Amyloid and Amyloidosis. Amer J Hemat 2005;79:319-28.</p><p>Городецкий В.Р., Пробатова Н.А., Логвиненко О.А. и др. Трудности диагностики лимфоидных неоплазий у больных ревматоидным артритом. Науч-практич ревматол 2009;3:94-100.</p><p>Логвиненко О.А., Васильев В.И. Неходжкинские лимфомы при ревматических заболеваниях. Науч-практич ревматол 2011;5:71-82.</p><p>Пальшина С.Г., Васильев В.И. Криоглобулинемический васкулит. Науч-практич ревматол 2010;4:59-66.</p><p>Schima W., Amman G., Steiner E. et al. Case report: Sicca syndrome due to primary amyloidosis. Br J Radiol 1994;67:1023-5.</p><p>Jardinet D., Westhovens R., Peeters J. Sicca syndrome as an initional symptom of amyloidosis. Clin Rheumatol 1998;17:546-8.</p><p>Kojima M., Itoh H., Shimizu K. et al. Malignant lymphoma in patients with systemic rheumatic disease (rheumatoid arthritis, systemic lupus erythematosus, systemic sclerosis, and dermatomyositis): a clinicopathologic study of 24 Japanese cases. Int Surg Pathol 2006;14(1):43-8.</p><p>Fujishima M., Komatsuda A., Imai H. et al. Amyloid arthropathy resembling seronegative rheumatoid arthritis in a patient with IgD-k multiple myeloma. Intern Med 2003;42:121-4.</p><p>Prokaewa T., Spencer B., Kaut M. et al. Soft tissue, joint and bone manifestation of AL amyloidosis. Arthr Rheum 2007;56:3858-68.</p></div><br />