We often see patients with persistent musculoskeletal pain, fatigue or recurrent injuries. In most cases, these symptoms are the result of overuse or minor trauma. However, there are occasions when symptoms don’t follow the expected pattern or fail to settle with standard treatment. In these cases, it’s critical to consider less common causes, one of which is multiple myeloma. While rare, multiple myeloma can sometimes be detected in a sports medicine clinic, particularly in older patients with persistent or unexplained pain. This blog discusses what multiple myeloma is, how it may present in active patients, and when to consider a screen.
What Is Multiple Myeloma?
Multiple myeloma is a type of blood cancer that originates in plasma cells, which are found in the bone marrow. These abnormal plasma cells multiply and interfere with the production of healthy blood cells. They also produce abnormal proteins that can cause damage to bones and organs. It typically occurs in people over the age of 60, although it can occasionally appear in individuals under the age of 60. The disease develops gradually and may not cause noticeable symptoms. As a result, diagnosis is often delayed.
One of the characteristic features of multiple myeloma is its impact on the musculoskeletal system. The disease can weaken bones, leading to pain, fractures, or bone collapse. This is why it’s particularly relevant to sports medicine specialists, who may see patients with unexplained bone pain or fractures. Understanding when to consider a multiple myeloma screen can help ensure that this condition is not missed.
Symptoms
Multiple myeloma can present in many ways, but bone pain is one of the most common early symptoms. This pain often affects the lower back, pelvis, ribs, or hips. About 50% of patients with multiple myeloma present with back pain. It may be dull and constant, occurring at rest or during the night. This is a critical distinction, as mechanical back or hip pain usually worsens with movement and improves with rest.
Another key feature of myeloma-related pain is that it does not respond to usual musculoskeletal treatment. Patients may not improve with physiotherapy or anti-inflammatory medication. In some cases, patients present with spontaneous fractures, particularly in the vertebrae of the spine. Crush vertebral fracture without significant trauma in younger patients is another concerning presentation.
Other common symptoms include fatigue, which may result from anaemia. Some patients report feeling unwell, with vague symptoms such as weight loss or low-grade fever. Recurrent infections can also be a clue, as the immune system is often compromised.
Sometimes, patients may present with symptoms related to hypercalcaemia, such as confusion, constipation, nausea, or abdominal pain. This occurs when the disease is actively breaking down bone.
From a musculoskeletal perspective, these red flags should raise concern and may warrant a multiple myeloma screen to explore possible underlying causes.
Myeloma Blood Screen:
Screening for multiple myeloma in a musculoskeletal setting is not routine, but it becomes crucial when symptoms are persistent, atypical, or unexplained. The goal is not to make a definitive diagnosis, but to identify cases where further investigation into multiple myeloma detection is warranted.
The first step is to take a careful history. Ask about pain patterns—whether the pain occurs at rest or night, whether it responds to load modification, and whether there has been any history of unexplained injury. Assess for other symptoms such as fatigue, weight loss, or frequent infections.
If concern remains, basic investigations can be performed to guide further management. These may include:
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Complete Blood Count (FBC): This can identify anaemia, which is common in myeloma.
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Erythrocyte Sedimentation Rate (ESR) or C-reactive protein (CRP): A raised ESR is often present in patients with myeloma.
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Serum Calcium and Kidney Function Tests: Multiple myeloma can lead to high calcium levels and kidney damage.
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Serum Protein Electrophoresis and Free Light Chain Assay: These tests should be ordered together to detect abnormal proteins produced by myeloma cells. Together, they detect about 98% of multiple myeloma cases.
If any of these tests are abnormal, referral to a haematologist is warranted for further assessment and detection of multiple myeloma through bone marrow biopsy and advanced imaging.
The Role of Imaging in a Multiple Myeloma Screen
Imaging is often part of musculoskeletal assessment in sports medicine and can provide essential clues when myeloma is suspected.
Plain X-rays may reveal small holes in the bone that appear “punched out” and are often called “lytic lesions.” These are most often seen in the spine, pelvis, and skull.
MRI is more sensitive and can more accurately detect early marrow involvement and compression fractures. If symptoms are unexplained and the MRI shows bone abnormalities without soft tissue damage, myeloma should be considered.
In some instances, haematology teams may use more advanced imaging, such as CT or PET scans, to evaluate the full extent of the disease.
Other frequently asked questions about a Multiple Myeloma Screen
What labs would be abnormal with multiple myeloma?
Generally, we perform serum protein electrophoresis and light chain assays to detect abnormal protein produced by the myeloma. Additionally, we look for anaemia, hypercalcemia, and elevated inflammatory markers.
What musculoskeletal presentations are suspicious for multiple myeloma?
Back, hip or pelvic pain that is not settling with treatment. Generally, pain is worse at night and unchanged with activity. Crush vertebral fractures without significant trauma in younger people are particularly suspicious.
Final Word from Sportdoctorlondon about Multiple Myeloma Screen
While multiple myeloma is a rare cause of musculoskeletal pain, it is an important diagnosis not to miss. If symptoms are persistent, non-mechanical, and unresponsive to standard care, consider initiating a multiple myeloma screen. Early multiple myeloma detection can dramatically improve outcomes and reduce the risk of serious complications like fractures and kidney damage.
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