Pearls of wisdom (1995) by the late Dr. Gilbert
Dear Members: For your information re bone and joint pains in MPN. Several of you have mentioned that you suffer from bone and/or joint pains – sometimes attributed to arthritis. I have seen a number of patients who have this complaint and it has been related to very active proliferative disease. There is a technique for demonstrating active sites of bone marrow proliferation using nuclear scans. The agent that is injected is technetium-sulfur-colloid. It is the same scanning agent that is used to image the liver and spleen. It is taken up by macrophages which are cells derived from monocytes and ultimately, from the bone marrow precursor cell that is involved in MPN.
In normal people bone marrow is confined to the central skeleton (cranium, ribs, sternum, vertebrae, and pelvis). The long bones contain mostly fat. In MPN, the bone marrow expands outward to the long bones and can be seen even out in the fingers and toes when bone marrow scanning is done.
The proliferation within the bone marrow cavity may cause pressure inside the bone that, in turn, causes inflammation of the covering of the bone (periostium).
The resulting periostitis may be painful. In some patients with bone and joint pain treatment with myelosuppressive therapy has decreased or eliminated these symptoms by reducing the amount of bone marrow in the cavity and reducing the pressure that it causes.
Although other forms of arthritis may be causing your pains, if no conventional cause is found, they may be due to MPN. Talk to your doctor about it if you have bone or joint pains. Also, consider gout which produces very acute arthritis involving only one joint. Hope this helps, Dr. Gilbert.
Note: This article was contributed to by the late Robert Tollen.