Abstract
The objectives of this study are to highlight the arthritic presentation of acute lymphoblastic leukemia (ALL) in children and to delineate features that could help differentiate it from juvenile idiopathic arthritis (JIA). We present a retrospective case control study based on records of the Pediatric Rheumatology Clinic, Advanced Pediatric Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India for the period January 2005–October 2008. We compared the clinical profile of 11 children referred to us with musculoskeletal complaints who were ultimately diagnosed to have ALL, with the clinical profile of an equal number of age and sex matched children with JIA. Important features that predicted a diagnosis of ALL and differentiated it from JIA were history of night pain (P = 0.001), non-articular bony pain (P = 0.001), presence of joint pain out of proportion to physical findings (P = 0.0001), anemia (P = 0.004), leucopenia (P = 0.045), lymphocytic predominance (P = 0.002) and thrombocytopenia (P = 0.012). In conclusion, children with musculoskeletal complaints are often referred to the rheumatologist for evaluation. The treating physician should always exclude the possibility of an underlying ALL especially if there are atypical clinical features or subtle hematological abnormalities.
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References
Margoloin JF, Steuber CP, Poplack DG (2005) Acute lymphoblastic leukemia. In: Pizzo PA, Poplack DG (eds) Principles and practice of pediatric oncology, 5th edn. Lippincott Williams and Wilkins, Philadelphia, pp 538–590
Revesz T, Kardos G, Kajtár P, Schuler D (1985) The adverse effect of prolonged prednisolone pretreatment in children with acute lymphoblastic leukaemia. Cancer 55:1637–1640
Glader B (2007) The Anemias. In: Kliegman RM, Behrman RE, Jenson HB, Stanton BF (eds) Nelson textbook of pediatrics, 18th edn. WB Saunders, Philadelphia, pp 2003–2006
Jonsson OG, Sartain P, Ducore JM, Buchanan GR (1990) Bone pain as an initial symptom of childhood acute lymphoblastic leukemia: association with nearly normal hematologic indices. J Pediatr 117:233–237
Bradlow A, Barton C (1991) Arthritic presentation of childhood leukaemia. Postgrad Med J 67:562–564
Schaller JG (1972) Arthritis as a presenting manifestation of malignancy in children. J. Pediatr 81:793–797
Tuten RH, Gabos PG, Kumar J, Harter GD (1998) The limping child: a manifestation of acute leukemia. J Pediatr Orthop 18:625–629
Spillberg I, Meyer GJ (1972) The arthritis of leukemia. Arthritis Rheum 15:630–635
Silverstein MN, Kelly PJ (1963) Leukemia with osteoarticular symptoms and signs. Ann Intern Med 59:637–645
Rogalsky RJ, Black B, Reed MH (1986) Orthopaedic manifestations of leukemia in children. J Bone Joint Surg [Am] 68:494–501
Gallagher DJ, Phillips DJ, Heinrich SD (1996) Orthopedic manifestation of acute pediatric leukemia. Orthop Clin North Am 14:635–644
Barbosa CM, Nakamura C, Terreri MT, Lee ML, Petrilli AS, Hilário MO (2002) Musculoskeletal manifestations at the onset of acute leukaemias in childhood. J Pediatr (Rio J) 78:481–484
Sinigaglia R, Gigante C, Bisinella Varotto G, Zanesco L, Turra S (2008) Musculoskeletal manifestations in pediatric acute leukemia. J Pediatr Orthop 28:20–28
Robazzi TC, Barreto JH, Silva LR, Santiago MB (2007) Osteoarticular manifestations as initial presentation of acute leukemias in children and adolescents in Bahia, Brazil. J Pediatr Hematol Oncol 29:622–626
Ostrov BE, Goldsmith DP, Athreya BH (1993) Differentiation of systemic juvenile rheumatoid arthritis from acute leukemia near the onset of disease. J Pediatr 122:595–598
Bichel J (1948) Arthralgic leukemia in children. Acta Haematol 1:154–164
Jones OY, Spencer CH, Bowyer SL, Dent PB (2006) A multicenter case–control study on predictive factors distinguishing childhood leukemia from juvenile rheumatoid arthritis. Pediatrics 117:e840–e844
D_Astous J, Corrigan M, Wiley J (1984) The musculoskeletal manifestations of acute lymphatic leukaemia in childhood. Orthop Trans 8:460
Cassidy JT, Petty RE (2005) Skeletal malignancies and related disorders. In: Cassidy JT, Petty RE, Laxer RM, Lindsley CB (eds) Textbook of pediatric rheumatology, 5th edn. Elsevier Saunders, Philadelphia, pp 739–740
Pui CH, Crist WM (1999) Acute lymphoblastic leukemia. In: Pui CH (ed) Childhood leukemias, 1st edn. Cambridge University Press, Cambridge, pp 288–312
Cabral DA, Tucker JB (1999) Malignancies in children who initially present with rheumatic complaints. J Pediatr 134:53–57
Rogalsky RJ, Black GB, Reed MH (1986) Orthopedic manifestations of leukaemia in children. J Bone Joint Surg Am 68:494–501
Clausen N, Gotze H, Pedersen A (1983) Skeletal scintigraphy and radiograph at onset of acute lymphocytic leukaemia in children. Med Pediatr Oncol 11:291–296
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Gupta, D., Singh, S., Suri, D. et al. Arthritic presentation of acute leukemia in children: experience from a tertiary care centre in North India. Rheumatol Int 30, 767–770 (2010). https://doi.org/10.1007/s00296-009-1064-7
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DOI: https://doi.org/10.1007/s00296-009-1064-7