In the early stages of myeloma, some patients have no signs or symptoms of the disease. It is sometimes detected before symptoms appear, when results of laboratory tests done as part of a routine medical examination show abnormalities in the blood and/or urine. When symptoms are present, the most common ones are bone pain and fatigue.
Doctors sometimes refer to the acronym, CRAB, to describe signs of myeloma. The letters stand for
- C - Calcium elevation (high levels of calcium in the blood; also known as “hypercalcemia”)
- R- Renal insufficiency (poor function of the kidneys that may be due to a reduction in blood-flow to the kidneys)
- A - Anemia (low red blood cell counts)
- B - Bone abnormalities (lesions).
Patients with one or more of these CRAB criteria, or with recurrent infections, are considered to have disease that requires treatment. Some patients have abnormalities which predict a very high probability of progression to active myeloma. Although they do not have symptoms, they may still require treatment. Other patients who do not exhibit any of these criteria are said to have “smoldering” or “asymptomatic myeloma,” and these patients may be followed with a watch-and-wait approach.
Some other symptoms of myeloma include:
- Bone pain and/or skeletal fractures. Bone pain is the most common early symptom of myeloma. Bones are constantly in a process of remodeling, maintaining a balance between bone destruction and formation. Myeloma causes an imbalance, with greater bone destruction and less new bone formation. This may result in bone thinning (osteoporosis) or holes in the bones (lytic lesions). Bones may break easily from activities as simple as coughing. The damage is most commonly found in the back or ribs, but it can occur in any bone. The pain is usually constant and made worse by movement. Bone lesions are present in about 80 percent of myeloma patients, most commonly in the spine and pelvis, but could affect any bone. Bone lesions are not usually found in joints.
- Fatigue and weakness as a result of low red blood cell counts (anemia). Myeloma patients may fatigue more easily and feel weak. They may also have a pale complexion from anemia.
- Frequent infections due to a weakened immune system. Myeloma patients may experience repeated infections because the antibodies they need to fight invading viruses, bacteria or other disease agents are not made efficiently or in adequate numbers. A urinary tract, bronchial, lung, skin or other type of infection may be the first sign of the disease. In addition, recurrent infections may complicate the course of the disease.
Other signs and symptoms include:
- Damage to kidneys from high levels of antibodies (proteins). The patient's urine may look foamy and the patient's legs may swell.
- Numbness, tingling, burning or pain in the hands or feet (caused by a condition called "peripheral neuropathy").
- In rare cases, patients can have hyperviscosity syndrome, when the blood thickens. Symptoms of hyperviscosity syndrome are abnormal bleeding, headaches, chest pain, decreased alertness or shortness of breath.
- Some patients can have amyloidosis, a condition in which the abnormal myeloma protein is deposited in various tissues in the body, causing damage.
If you experience by any of the above symptoms, see your doctor. Sometimes, you may have no symptoms. In this case, your doctor may first detect the disease as a result of a lab test or an X-ray taken for another reason.
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