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MGUS and Autoimmune Disease

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For as long as I can remember, there has been a relationship between MGUS and Autoimmune Disease. The study linked and excerpted below questions that relationship.

I am a MM survivor and I communicate with MGUS patients throughout my week. A topic that often comes us is the patient’s autoimmune disease.

There were many, many patients who had an autoimmune diseases (lupus, MS, RA, etc) as well as MGUS.


is MGUS related to autoimmune diseases?

  • Increased Prevalence in Autoimmune Diseases: Studies have shown that MGUS is more prevalent in individuals with certain autoimmune diseases compared to the general population. This suggests a potential link between the dysregulation of the immune system seen in autoimmune conditions and the development of MGUS.
  • Shared Pathogenic Mechanisms: Both MGUS and autoimmune diseases involve abnormalities in the immune system. In autoimmune diseases, the immune system attacks the body’s own tissues, while in MGUS, there is an abnormal proliferation of a single clone of plasma cells producing a monoclonal protein. Chronic immune stimulation, often seen in autoimmune diseases, may contribute to the development of MGUS.
  • Specific Autoimmune Diseases Linked to MGUS:
    • Rheumatoid Arthritis: Increased prevalence of MGUS has been reported in patients with rheumatoid arthritis.
    • Systemic Lupus Erythematosus (SLE): Higher rates of MGUS have also been observed in individuals with SLE.
    • Sjogren’s Syndrome: This autoimmune disorder affecting the moisture-producing glands has been associated with a higher incidence of MGUS.
  • Clinical Implications: The presence of MGUS in individuals with autoimmune diseases may have implications for their management and monitoring. It is important for healthcare providers to be aware of this association, as MGUS can progress to more serious conditions like multiple myeloma, albeit at a low rate.
  • Immune System Dysregulation: The exact mechanisms linking MGUS to autoimmune diseases are not fully understood but likely involve chronic immune activation and dysregulation, leading to the clonal expansion of plasma cells.

I cannot help but doubt the findings of the study below. At this point, the most I can do is to continue to promote evidence-based non-conventional therapies for pre-MM shown to reduce the risk of a MM diagnosis such as:

man hand holding his nutritional supplemets, healthy lifestyle background.

  • Nutrition
  • Supplementation
  • Lifestyle Therapies

 

David Emerson

  • Myeloma Survivor
  • Myeloma Cancer Coach
  • Director PeopleBeatingCancer

Doubt Cast on MGUS-Autoimmune Disease Link

“Contrary to earlier studies, the not-entirely-rare condition known as monoclonal gammopathy of undetermined significance (MGUS) did not appear to raise risk for autoimmune disease when examined in the general population.

In a broad-based screening study performed in Iceland, rates of MGUS — an asymptomatic abnormality in bone marrow plasma cells, which then produce ineffectual but benign immunoglobulins — were no higher in people with autoimmune diseases than in otherwise healthy individuals (prevalence ratio 1.05, 95% CI 0.97-1.15), according to Ingigerdur Sverrisdottir, MD, of the University of Iceland in Reykjavik, and colleagues.

“Our findings have direct clinical relevance,” the researchers wrote in the Annals of Internal Medicineopens in a new tab or window, “because they suggest that recommendations to routinely screen patients with autoimmune disease for MGUS may not be warranted.”

Yet while MGUS might have been exonerated as a promoter of autoimmune disease, the “undetermined significance” part of its name remains something of a misnomer. Not only does the new study come with important limitations, but it did not question earlier findings that MGUS often precedes development of multiple myelomaopens in a new tab or window. “Each year, approximately 1% of patients with MGUS and 0.3% of patients with [light-chain] MGUS progress to [multiple myeloma] or other malignant conditions,” Sverrisdottir and colleagues noted. Overall, they observed, something like 3%-4% of older people have standard MGUS, while about 1% have the light-chain form.

It had been thought that MGUS is a factor in some cases of autoimmune disease, because observational studies found increased prevalence of MGUSopens in a new tab or window in people with disorders such as rheumatoid arthritis, systemic sclerosis, and Sjögren’s syndrome. But, according to Sverrisdottir and colleagues, “patients seeking medical care are more likely to get tested for various conditions, including MGUS.” Consequently, they continued, the studies finding increased rates of MGUS in autoimmune disease patients “have a built-in ascertainment bias.”

A better approach, the group explained, would be to look for MGUS in conjunction with autoimmune disease in the general population. Exactly that type of data was available from a trial conducted in Iceland called iStopMMopens in a new tab or window, which “aimed to investigate the benefits and harms of screening for MGUS” as a means of identifying people at heightened risk for multiple myeloma. This trial screened more than 75,000 Icelandic residents age 40 and older for MGUS starting in 2016 — representing roughly half of all Icelanders in that age group. Blood samples were tested for the so-called M protein, the hallmark deformed immunoglobulin produced in MGUS. Participants’ records in the country’s universal medical registry were then scanned for previous diagnoses or treatments for 42 different autoimmune diseases.

About 3,670 people with MGUS were identified in the screening; 298 individuals had a prior diagnosis of MGUS, but screening results were negative in 77. In the screening-positive population, 599 had some type of autoimmune disease. But that rate was nearly the same as was seen in the screening-negative group.

As well, when autoimmune diseases were stratified into four subtypes — autoantibody-positive, autoantibody-negative, organ-specific, and systemic — there was no suggestion of increased risk for MGUS in any of these in the screening population. Nor did the MGUS subtype (IgG, IgA, IgM, biclonal, or light-chain) seem to matter.

Sverrisdottir and colleagues did find roughly doubled rates of previously diagnosed autoimmune disease among the 298 people with a previous clinical diagnosis of MGUS, compared with MGUS-negative individuals. But that was most likely another example of the ascertainment bias inherent in people with autoimmune disease, the researchers argued.

Two substantial limitations were noted in their paper: the study’s conduct in Iceland, where the population is overwhelmingly white-Scandinavian, and its reliance on registry records. With regard to the latter, the researchers acknowledged, “the high accuracy of coding for chronic conditions shown in a validation study has not been demonstrated specifically for autoimmune diseases.” It was also possible that people with previous health conditions were more likely than others to agree to participate in iStopMM, which would introduce bias.

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