Discussion
Scleroderma is an autoimmune connective tissue disease, usually affects
people of 30–50 years age group, with a female predominance
(1).Patients with scleroderma can have specific antibodies such as
antinuclear antibody, anticentromere or antitopoisomerase in their blood
which suggest autoimmunity.
Our patient is 58-year-old female with systemic sclerosis and positive
ANA and ScL 70.
Scleroderma is a disease with unknown etiology(1), but there may be a
history of a preceding infection in most cases(2); however, associations
have also been reported with diabetes, systemic lupus erythematosus,
rheumatoid arthritis, Sjogren syndrome, monoclonal gammopathy, and
MM(2,3).
There is possibility that inflammation , molecular deregulation events,
and the circulating factors inducing immunostimulation of B cells in
autoimmune disorders precede clonal proliferation of plasma cells and
lead to the emergence of MM. The second possibility of developing MM may
be related to the use of immunosuppressive drugs. In addition, a common
genetic susceptibility for developing both an autoimmune disease and MM
might also exist (2,3).
In our case the treatment of methotrexate could be a possible cause for
MM development.
In literature cases of scleroderma associated with monoclonal gammopathy
of undetermined significance have been reported. However, association of
scleroderma with MM is rare
(Table
2). Patients’ age ranged from 37 to 76 years, with variable duration of
developing MM after the diagnosis of scleroderma. This duration ranges
from 1 month to 40 years. Our patient was diagnosed with MM after a
period of 10 years of SSc diagnosis.
Table 2: Cases of systemic sclerosis with multiple myeloma