Joint symptoms in myelomatosis and similar conditions.

The commonest presenting symptom in myelomatosis is pain in the back, which is frequently associated with vertebral collapse. Subsequently the patient may complain of sciatica or brachial neuralgia due to nerve root pressure. This may be a direct result of the collapse, or in some cases may be caused by an extradural plaque of myeloma cells. A less common but well-recognized presentation is a polyarthritis, which superficially resembles rheumatoid arthritis and is usually treated as such in the first instance. 24 cases of this type have now been reported in the literature; among the most important reports are those of Magnus-Levy (1938), Stewart and Weber (1938), Tarr and Ferris (1939), and Davis, Weber, and Bartfeld (1957). Such a patient is middle-aged and develops an arthritis which may or may not be painful. The pattern of joint involvement is variable, but the small joints of the hands frequently become swollen. A careful examination may reveal the presence of nodules in the neighbourhood of joints, attached to bony prominences, or in skeletal muscle, and in two of the thirteen cases reviewed by Tarr and Ferris there was macroglossia. Biopsy or autopsy examination of affected joints or of nodules will show infiltration with para-amyloid. This apparent arthritis frequently precedes any overt manifestations of myelomatosis, but it can develop during the course of the disease. It should not be confused with pain seeming to arise in joints from myelomatous involvement of adjacent bone, which is not uncommon in the hips and shoulders. Recently we have seen several patients with arthritis who on subsequent investigation have been found to have myelomatosis, and the purpose of this paper is to review these cases against a background of all cases of myelomatosis seen at the