A couple of recent articles have highlighted Lyme disease. One article appeared on the front page of yesterday's Sunday Globe. It traces the sad history of one woman who suffered long-term debilitating effects of Lyme disease and was confronted by a medical community which was dismissive and in denial. Familiar story? Then today, the CDC announced that the actual incidence of Lyme is about 10 times more prevalent than previously thought. They now estimate about 300,000 people a year get Lyme. Of course, the article then goes on to suggest preventive measures to reduce the incidence of tick bites. That's nice, but what about doing something about the ones who get bit? No suggestions there. It makes me want to go into a closet, close the door, and let out an inarticulate scream at the top of my lungs.
My last post generated several responses from MM or MGUS patients who have suffered very similar patterns of previous immune system symptoms that I experienced from my untreated Lyme disease. It's disturbing to read how dismissive the medical establishment has been of their (and my) plights. Of course, several anecdotal situations such as these don't constitute evidence that there is a statistical correlation between any of these various autoimmune diseases or infections and myeloma.
I've done a little further online research to uncover any studies that may have addressed this issue. One of the studies analyzing the association between a number of diseases and MGUS was reported by the respected myeloma specialist, Dr. Vincent Rajkumar of the Mayo Clinic. The study included a lot of Minnesota MGUS patients. Here is a YouTube video on this study: Rajkumar video. For the most part, his study dismissed most diseases as not being correlated with MGUS. His conclusion was that any association between certain diseases, such as Rheumatoid Arthritis (RA) and Lupus, was probably incidental. However, when I accessed the full paper, I noticed that Lyme disease was not one of the specific infections investigated. This was a little disappointing, especially since Minnesota is one of the hot beds of Lyme disease.
On the other hand, another well-respected myeloma expert, Dr. James Berenson, has a different take on this. In his short YouTube video, Berenson video, he acknowledges a correlation between the autoimmune disorders RA and Lupus with MGUS. Jeez, I wish these guys would talk to each other.
The most interesting study that I have come across is a Swedish study that appeared in the journal Blood in December, 2011. This article concluded that a personal and family history of immune-related conditions increase the risk of plasma cell disorders. Here is a link to the paper:
In this large population study, they analyzed over 19,000 MM patients and over 5,000 MGUS patients, along with nearly 100,000 control subjects. They studied the association of a variety immune-related conditions with both MGUS and MM. They addressed four different categories: 1) personal history of autoimmune disease, 2) family history of autoimmune disease, 3) personal history of infections, and 4) personal history of inflammatory conditions.
For those with personal history of autoimmune disease where the autoantibodies are detectable (such as RA and Lupus), there was significant correlation with MGUS, but not MM. (Score one for Berenson!). For those where the autoantibodies are not detectable (such as hemolytic anemia, polymyalgia rheumatica, and giant cell arteritis), a significantly elevated risk of MM was found. Interestingly, there was a negative correlation between RA and MM, unlike with MGUS, although the authors noted that other studies have shown either neutral or a positive correlation between RA and MM.
It was found that a family history of autoimmune disease was associated with a significantly increased risk of MGUS, but not MM.
I was particularly interested in the results for those with a personal history of infections. Overall, infections were associated with a significantly increased risk of both MM and MGUS! A history of pneumonia, septicemia, herpes zoster (shingles), infectious mononucleosis, sinusitis,
meningitis, and myocarditis was associated with a significantly increased risk of MM. Many more infections were highly associated with MGUS. One of the highest positive correlations between prior infections and MGUS was Lyme disease! (Interestingly, and somewhat puzzlingly, they did not observe a strong correlation between Lyme disease and MM.)
In the final category, inflammatory conditions were associated with a significantly increased risk of subsequent MGUS, but not MM.
In the authors' discussion, I found the following passage to be of particular interest: "...certain infections and inflammatory conditions can trigger the
development of MGUS or MM. Approximately
one-half of MGUS patients have clonal plasma cells
carrying translocations that involve a locus considered to be of
for initiation and support of clonal proliferation. It has previously been proposed that infections could be the trigger event for these translocations and thereby generate
clonal proliferation, and our findings support this." Wow! Could it be that my t(4;14) translocation was in part triggered by the long-term effect of chronic Lyme disease on my immune system? It sure seems plausible.
The more I look into this, the more I become convinced that assaults on the immune system from various causes, including chronic Lyme disease, lead to elevated risk of subsequently developing MGUS and/or MM.