A case of multiple myeloma presenting as multiple arthralgia

A case of multiple myeloma presenting as multiple arthralgia

An 85-year- o l dwoman, presentedcomplaining ofmorning stiffnessand bilateral hip,knee, and shoulderpain that had beenongoing for morethan three months.Furthermore, shehad difficulty ingetting up from achair. She visited ageneral physicianwhere rheumatoid arthritis was suspected due tomultiple arthralgia,the presence of rheumatoid factor and an elevated erythrocyte sedimentation rate. A radiographof her left hip joint taken in our clinic revealed osteolytic lesions (Fig.1a), and a pathologicalfracture occurred afterwards. Skull radiograph revealed punched-out lesions (Fig.1b).Laboratoryblood testing revealed hemoglobin 5.7 gm/dL, total protein 9.0gm/dl, albumin 3.1gm/dl, calcium8.2mg/dl, creatinine 1.0 mg/dL, CPK 143 U/L, IgG 4818 mg/dL, IgA<33mg/dL. Serum proteinelectrophoresis revealed monoclonal spike (IgG and kappa) and bone marrow biopsy revealedplasma cell myeloma.