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