Interdisciplinary approach to multiple myeloma - time to diagnosis and warning signs.

Herget, Georg W; Kälberer, Felix; Ihorst, Gabriele; Graziani, Giulia; Klein, Lukas; Rassner, Michael; Gehler, Christian; Jung, Johannes; Schmal, Hagen; Wäsch, Ralph; Engelhardt, Monika

Delayed diagnosis is a common challenge in the management of multiple myeloma (MM). This prospective interdisciplinary study evaluated symptoms and time to diagnosis (TTD) in 81/295 screened patients at our tertiary center, who were examined by an orthopedist prior to the MM diagnosis. The most frequent complaint was back pain (81%), mainly localized thoracic and/or lumbar. Pain was independent of movement in 85%, occurred at night in 69%, and at multiple localizations in 30% of patients. Notably, 63% patients with an orthopedic disease noticed substantial symptom change before the MM diagnosis was made. The median TTD was 7 months and did not differ significantly between patients with or without a preexisting skeletal disease. To avoid delayed diagnosis, physicians should consider MM as a differential diagnosis, whenever warning signs such as skeletal pain independent from movement, at night, at various localizations, and change in pain characteristics accompanied by fatigue, are reported.