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Arthritic presentation of acute leukemia in children: Experience from a tertiary care centre in North India
Rheumatology International, 07/30/09

Gupta D et al. – Leukemia is an important differential diagnosis in children presenting with osteoarticular complaints. Clinical and laboratory features inconsistent with diagnosis of rheumatic etiology should be seen as pointers toward this diagnosis, especially when there are additional corroborative findings on the hemogram (e.g., severe anemia, leucopenia, lymphocytic predominance, and thrombocytopenia). Under such circumstances, the treating physician should request a bone marrow examination before initiating treatment.

Methods

Study 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)
A retrospective case control study based on records of the Pediatric Rheumatology Clinic, India for the period Jan 2005–Oct 2008
Clinical profile of subjects:
- 11 children with musculoskeletal complaints who were ultimately diagnosed to have ALL
- An equal number of age and sex matched children with JIA
  were compared

Results

Important features that predicted a diagnosis of ALL and differentiated it from JIA were:
- history of night pain, non-articular bony pain,
- presence of joint pain out of proportion to physical findings,
- anemia, leucopenia, lymphocytic predominance and thrombocytopenia

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