History and exam

Key diagnostic factors

common

at-risk demographic (male, age >50 years, African ancestry)

Men have higher rates of MGUS than women, reflected in age-adjusted ratios of 4.0 in 100 for men versus 2.7 for women.[5][6]

MGUS is present in about 3% of the general white population aged 50 years or older; it is 2 to 3 times more common among black people than white people.[5][6][7][8][9]

clinically asymptomatic

Hepatosplenomegaly, lymphadenopathy, chronic or intermittent bone pain, weight loss, diarrhoea, dysphagia, oedema, dyspnoea, dizziness, bleeding and bruising, and night sweats or fever, may be indicative of progression to another disorder, such as lymphoma, chronic lymphocytic leukaemia, multiple myeloma, or amyloidosis.

uncommon

positive family history

Risk for MGUS is increased approximately 2- to 3-fold in first degree family members of patients with MGUS or multiple myeloma.[8][13][14]

history of radiation exposure

A screening study of atomic bomb survivors suggested radiation exposure as a possible predisposing factor for MGUS.[17]​

history of pesticide exposure

In one study, the prevalence of MGUS among men involved in the application of agricultural pesticides was twice that of a population-based sample of men.[18]

Other diagnostic factors

uncommon

history of immunosuppression or infections

Population-based studies suggest an association between a personal history of autoimmune disease or infection and a subsequent diagnosis of MGUS.[8][15]

Clinical observations indicate that decreased immunoglobulin levels (which may cause recurrent infections) could be a manifestation of undetected MGUS.

Anecdotal evidence suggests that MGUS may be more common among HIV-infected or transplant patients.[16]

presence of peripheral neuropathy

Patients with IgM gammopathy may present with typical sensory symptoms such as paraesthesia, dysaesthesia, or neuropathic pain associated with ataxia and gait disturbance. They may lack specific autoantibodies to confirm the causal association between monoclonal gammopathy and polyneuropathy.

It is thus important to consider the possibility of other polyneuropathies such as chronic inflammatory demyelinating polyneuropathy and paraneoplastic, metabolic, and toxic neuropathies, which may co-exist with a monoclonal protein, and arrange for appropriate management.

Risk factors

strong

male sex

Men have higher rates of MGUS than women, reflected in age-adjusted ratios of 4.0 in 100 for men versus 2.7 for women.[5][6]

age >50 years

MGUS is present in about 3% of the general white population aged 50 years or older.[5][6]

African ancestry

MGUS is 2 to 3 times more common in black people than in white people.[6][8][8][9]

family history of MGUS or multiple myeloma

Risk for MGUS is increased approximately 2- to 3-fold in first-degree family members of patients with MGUS or multiple myeloma.[8][13][14]

There are no data to suggest that the risk for transformation from MGUS to multiple myeloma differs between familial and sporadic MGUS.[8]

radiation exposure

Based on results from a screening study conducted among atomic bomb survivors, radiation exposure has been suggested as a possible predisposing factor for MGUS.[17]​

pesticide exposure

In one study, the prevalence of MGUS among men involved in the application of agricultural pesticides was twice that of a population-based sample of men.[18]

weak

immune-mediated conditions

Population-based studies suggest an association between a personal history of autoimmune disease or infection and a subsequent diagnosis of MGUS.[8][15]

Clinical observations indicate that decreased immunoglobulin levels (which in turn may cause recurrent infections) could be a manifestation of undetected MGUS. Anecdotal evidence suggests that MGUS may be more common among HIV-infected or transplant patients.[16]

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