clinical features

Last reviewed 06/2023

Common in older adults - median age 60 years; M >F

Presenting clinical features include symptoms of:

• bone disease

• patients may initially present with unexplained backache or bone pain
• long bones, ribs, skull, and pelvis are also commonly involved
• may present as a pathologic fracture (26 to 34% of patients) following minimal trauma, especially of the femoral neck
• weakness and paresthesias in the lower extremities due to vertebral compression fractures
• carpal tunnel syndrome - the most common peripheral neuropathy associated with multiple myeloma

• anaemia

• fatigue and malaise

• recurrent or persistent bacterial infection

• due to suppression of antibody production and neutropenia
• commonly with encapsulated organisms such as Streptococcus pneumoniae, Haemophilus influenzae;

• hypercalcaemia

• nausea, fatigue, confusion, polyuria, constipation (1,2)

• renal failure  

• occurs in 20 to 40% of patients
• due to direct tubular damage from excess protein load, dehydration, hypercalcemia, and the use of nephrotoxic medications (3)
• aggravated by hypercalcaemia

• weight loss

• occurs in less than one fourth of patients (1,2)

• hyperviscosity -

• mucosal bleeding, vertigo, nausea, visual disturbances, alterations in mental status
• hyperviscosity syndrome is more common in IgA than IgG disease

• fever (3)

On examination:

• bone tenderness may be present at the sites of growth
• occasionally soft tissue masses
• neuropathy related to tumourous infiltration of nerve root trunks - symmetric sensorimotor, gradual in onset, and progressive, with pain and dysesthesia (impairment of any sense, especially touch) in limbs; more common in men
• lymphadenopathy and splenomegaly are exceptional
• hepatomegaly is common

Reference:

• (1) Bird JM et al. Guidelines for the diagnosis and management of multiple myeloma 2011. Br J Haematol. 2011;154(1):32-75.  
• (2) Nau KC, Lewis WD. Multiple myeloma: diagnosis and treatment. Am Fam Physician. 2008;78(7):853-9.  
• (3) Palumbo A, Anderson K.Multiple myeloma. N Engl J Med. 2011;364(11):1046-60.