A rapidly destructive amyloid arthropathy associated with myeloma.

Amyloid arthropathy is a known complication of multiple myeloma. Clinically, it can be confused with RA with a symmetrical swelling of small and large joints. However, radiologically it can produce bone cysts, but it is said to be distinguished from RA by preservation or even widening of the joint space. We describe a 53-year-old man with myeloma who developed a rapidly destructive rare form of amyloid arthropathy within months of his hematologic diagnosis. The myeloma was aggressive and only partially responsive to treatment; this may have influenced the severity of the joint disease. The arthritis had minimal improvement with the chemotherapy. Intraarticular injections with depot corticosteroids gave some symptomatic relief. Two other unusual features were an unexplained inflammatory arthritis of an elbow with associated soft tissue calcification. If other causes are excluded, amyloidosis may account for a more destructive arthritis than is generally recognized.