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Arthritis as the presenting feature of acute lymphoblastic leukaemia
The presentation of leukaemia is not always typical and this can potentially lead to diagnostic delay. Brix and colleagues report their experience of joint involvement at presentation in a retrospective cohort (286 patients, 21 years). 53/286 presented with localised joint pain half of which had objective signs of arthritis, most commonly an oligoarthritis. Initial impressions at presentation were of a reactive arthritis (19), osteomyelitis (9) and juvenile idiopathic arthritis (8). Children with joint involvement had, in general, fewer objective signs of haematological disease (cytopenia absent in 24% v 8%, no organomegally in 44% versus 29%). The difficulty is should everyone who presents with joint pathology be investigated for leukaemia. This is discussed in the accompanying editorial—Are you missing leukaemia? It is important to remember that if this issue is looked at in a different way children who present with joint pathology rarely have leukaemia and so the decisions regarding how intensively to investigate remain a clinical decision based on specific features and the risk benefit of testing being done. See pages 821 and 811
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