On-line version ISSN 2309-8309
SA orthop. j. vol.8 n.4 Pretoria Jan. 2009
HF VisserI; A VisserII; CH SnyckersIII; R GollerI; R PoolIV; JG MyburghV
IMBChB(Pret); Senior Registrar, Department Orthopaedic Surgery, University of Pretoria
IIMBChB(Pret); Senior Registrar, Department Clinical Pathology, University of Pretoria, National
IIIMBChB, MMed(Orth)(Pret); Consultant, Department Orthopaedic Surgery, University of Pretoria
IVMBChB(Pret), MMed(Haemat); Head of Department, Department Haematology, University of Pretoria, National Health Laboratory Service TAD
VMBChB, MMed(Orth)(Pret); Acting Head of Department, Department Orthopaedic Surgery, University of Pretoria
PURPOSE OF THE STUDY: Despite the relatively high incidence of multiple myeloma reported worldwide, South African statistics seem to be significantly lower. Our purpose in doing this study was to determine whether patients with suspected immunosecretory disorders are being appropriately evaluated and followed up. Secondary purposes include an impression of the most common clinical features prompting investigation as well as the stage of disease at time of diagnosis.
DESCRIPTION OF METHODS: All patients investigated for immunosecretory disorders by serum or urine electrophoresis over a 4-year period were included in this study. Each patient's laboratory and radiological data were evaluated to determine the true diagnosis, and assess the comprehensiveness of the investigation.
SUMMARY OF RESULTS: In total, 582 patients were included - 39 patients had multiple myeloma (6.7%). A single case of plasmacytoma and plasma cell leukaemia was identified. Waldenström's macroglobulinaemia was identified in seven patients (1.2%) and monoclonal gammopathy of undetermined significance (MGUS) in 83 patients (14.3%). Due to the risk of progression from MGUS to multiple myeloma, patients need to be re-evaluated biannually, shown to be the case in only 11% of cases.
Of all the malignant disorders (48 cases) the majority of patients were diagnosed in an orthopaedic setting (45%), followed by internal medicine (39%). Radiological abnormalities were the most common clinical finding prompting investigation, with lytic lesions or osteoporosis seen in 50%, pathological fractures in 17% and neurological manifestations noted in 18% of cases.
The majority of patients who could be staged were diagnosed at a relatively late stage of disease, rendering the prognosis worse than in early disease. This suggests a relatively low index of suspicion in our clinical setting.
CONCLUSION: Multiple myeloma and related disorders are commonly encountered in the orthopaedic setting. Although the sample size is small, this data suggests that patients are diagnosed late in disease progression and often not evaluated appropriately. A clear protocol should be established to actively exclude this diagnosis if it is suspected.
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Dr A Visser
This article is the sole work of the authors. No benefits of any form have been received from a commercial party related directly or indirectly to the subject of this article although a grant has been applied for.