Rheumatic manifestations of hematologic malignancies: Correlation with laboratory markers

Abstract

Objective: To determine the rheumatic manifestations associated with hematologic malignancies namely acute and chronic leukemia, Hodgkin’s and non-Hodgkin’s lymphomas, and multiple myeloma; and the markers correlating with their presence.
Methods: Eighty patients with hematologic malignancies (28 leukemia, 28 lymphoma and 24 multiple myelomas) were evaluated and examined for the presence of rheumatic manifestations, clinically, radiologically, and by bone scan. Two groups of controls: clinical and laboratory (80 and 15 healthy individuals from the normal population respectively) were also studied. Routine laboratory tests and bone marrow aspiration were done for all patients, while serum rheumatoid factor (RF), antinuclear antibodies (ANA), creatine phosphokinase (CPK), and serum beta-2 macroglobulin were assessed as a marker for rheumatic manifestations in patients and controls.
Results: Rheumatic manifestations were identified in 50 patients with hematologic malignancies (62.5%) and 21 clinical controls (26.3%) (p< 0.001, odds ratio=4.7, and 95% confidence interval=2.4-9.2). Arthralgia and low back pain were the most significantly rheumatic manifestations associated with hematological malignancies in comparison with healthy controls (OR=15.4, and OR=3.4 respectively). Serum beta-2 macroglobulin was elevated in 38 patients (47.5%), rheumatoid factor was positive in 30 patients (37.5%), and ANA was found in 19 (23.7%) with a significant difference between patients and laboratory controls. 60 patients (75%) had radiological findings and 19 patients (23.75%) had an increased uptake in bone scan. Serum beta-2 macroglobulin was positively correlated with rheumatic manifestations (r=0.21, p=0.02), osteopenia in x-rays (r=0.24, p=0.03), and increased uptake in bone scan (r=0.41, p< 0.001).
Conclusion: Rheumatic manifestations occur in 62.5% of patients with leukemia, lymphoma, and myeloma, significantly more commonly than in age and sex-matched controls. They may precede the other manifestations of malignancy (31.3%), occur during the course of illness (25%) or follow as a complication of chemotherapy (6.3%). Serum beta-2 macroglobulin is a useful laboratory test, being a marker for the presence of rheumatic manifestations and predicting osteopenia in x-rays and increased uptake in bone scan.