The most common cause of presentation to the doctor is bone pain, usually pain in the spine where the disease has weakened the vertebra and caused painful and sometimes collapsed vertebrae, pinching or crushing the exiting nerve roots from the spinal canal. Sometimes, the collapsed vertebrae may compromise the integrity of the spinal canal itself causing pressure on the spinal cord and leading to weakness in the legs, which is a serious development that is always taken very seriously.
Alternatively, as most of the marrow containing bones are 'softened' by the myeloma process, the patient may present with a fracture of a long bone (e.g. the upper arm bone or leg bone), following minor trauma.
Other less common presentation symptoms relate to anaemia due to the disease 'over-running' the bone marrow (and an increased bleeding tendency may have the same origin) or kidney failure (a well recognised secondary phenomenon in this disease).
Metabolic complications account for the minority of cases and include a very high serum calcium (hypercalcaemia) or a hyperviscosity state due to an excess circulating IgM, both these events causing drowsiness and general ill health. The excess of IgM occurs in a variant disease called Waldenstrom’s macroglobulinaemia.
Lastly and very importantly, these patients are very immune deficient and are at high risk of infection. Indeed, they may present with a serious infection.