Barbosa Cássia Maria Passarelli Lupoli, Nakamura Cláudia, Terreri Maria Teresa, Lee Maria Lúcia de Martino, Petrilli Antonio Sergio, Hilário Maria Odete Esteves
Dep de Pediatria, Universidade Federal de São Paulo, SP.
J Pediatr (Rio J). 2002 Nov-Dec;78(6):481-4.
To study the frequency, the clinical features and laboratory exams of patients with musculoskeletal symptoms at the onset of acute leukemia.
Retrospective, descriptive study including patients diagnosed with acute leukemia, and treated at the Institute of Pediatric Oncology of UNIFESP, carried out from November 1999 to February 2000. The data on musculoskeletal complaints were obtained from a questionnaire. The medical records were revised in order to get data on the clinical examination and laboratory tests at the beginning of the illness.
Sixty-one children were included in this trial, 93% with acute lymphoid leukemia, and 7% with acute myeloid leukemia. Thirty-eight patients (62%) had musculoskeletal pain at the onset. Arthritis was observed in eight patients. The mean number of involved joints was 2.5 (1-6). The most frequently involved joints were the knees, ankles and elbows. Three patients (4.9%) had normal blood count. Low hemoglobin was reported in 54 patients (88%) (in six patients it was the only hematological abnormality), leukopenia in 14 (22%), leukocytosis in 26 (42%) and low platelet count in 46 (75%).
The musculoskeletal symptoms are common at the onset of acute leukemia so, malignancy should always be ruled out in patients presenting chronic or acute arthritis or benign limb pain. The laboratory tests may be normal at the onset of the illness, making differential diagnosis more difficult.
研究急性白血病发病时出现肌肉骨骼症状患者的发生率、临床特征及实验室检查结果。
回顾性描述性研究，纳入1999年11月至2000年2月期间在圣保罗联邦大学儿科肿瘤研究所诊断并接受治疗的急性白血病患者。通过问卷调查获取肌肉骨骼症状相关数据。查阅病历以获取疾病初期临床检查和实验室检查的数据。
本试验纳入61名儿童，其中93%为急性淋巴细胞白血病，7%为急性髓细胞白血病。38名患者（62%）发病时出现肌肉骨骼疼痛。8名患者观察到关节炎。受累关节的平均数量为2.5个（1 - 6个）。最常受累的关节是膝关节、踝关节和肘关节。3名患者（占4.9%）血常规正常。54名患者（88%）血红蛋白低（6名患者中这是唯一的血液学异常），14名患者（22%）白细胞减少，26名患者（42%）白细胞增多，46名患者（75%）血小板计数低。
急性白血病发病时肌肉骨骼症状常见，因此，对于出现慢性或急性关节炎或良性肢体疼痛的患者，应始终排除恶性肿瘤。疾病初期实验室检查可能正常，这使得鉴别诊断更加困难。
