Brix Ninna, Rosthøj Steen, Herlin Troels, Hasle Henrik
Department of Pediatrics, Aarhus University Hospital Skejby, Aarhus, Denmark.
Department of Pediatrics, Aalborg University Hospital, Aalborg, Denmark.
Arch Dis Child. 2015 Sep;100(9):821-5. doi: 10.1136/archdischild-2014-307751. Epub 2015 Jul 27.
At disease onset, children with acute lymphoblastic leukaemia (ALL) may present with arthralgia or even signs of arthritis. This might cause misdiagnosis and thereby lead to prolonged diagnostic delay. The present study aimed to identify children with ALL with joint involvement and to compare their characteristics and outcome with children with ALL without joint involvement.
Case records of 286 children diagnosed with ALL between 1992 and 2013 were reviewed and analysed in this retrospective, descriptive study.
Fifty-three (18.5%) children with ALL presented with localised joint pain, and half of them had objective signs of arthritis. The mean number of joints involved was 2.5, most frequently presenting as asymmetric oligoarthritis. The suspected misdiagnosis were reactive arthritis (19/53), osteomyelitis (9/53) and juvenile idiopathic arthritis (8/53). Children with joint involvement had less objective signs of haematological disease. Cytopenia was absent in 24% in children with joint involvement (vs 8% without, p=0.001), 50% had only one cell line affected (vs 21%, p=0.0005) and 44% had no organomegaly (vs 29%, p=0.05). Median diagnostic delay was 4 vs 2 weeks. The 5-year event-free and overall survival was superior for children with joint involvement: 94% vs 87% (p=0.049), and 96% vs 83% (p=0.044).
ALL with joint involvement is a frequent finding (18.5%). The clinical signs of leukaemia are less prominent, but non-articular pain should alert the clinician of a possible diagnosis of leukaemia. The overall and event-free survivals were superior compared with the children without joint involvement.
急性淋巴细胞白血病（ALL）患儿在疾病初发时可能出现关节痛甚至关节炎体征。这可能导致误诊，进而造成诊断延误时间延长。本研究旨在识别有关节受累的ALL患儿，并将其特征及预后与无关节受累的ALL患儿进行比较。
在这项回顾性描述性研究中，对1992年至2013年间确诊为ALL的286例患儿的病例记录进行了回顾和分析。
53例（18.5%）ALL患儿出现局部关节疼痛，其中半数有客观的关节炎体征。受累关节的平均数量为2.5个，最常见的表现为不对称性少关节炎。疑似误诊疾病包括反应性关节炎（19/53）、骨髓炎（9/53）和幼年特发性关节炎（8/53）。有关节受累的患儿血液系统疾病的客观体征较少。关节受累患儿中24%无血细胞减少（无关节受累患儿为8%，p=0.001），50%仅有一个细胞系受累（无关节受累患儿为21%，p=0.0005），44%无器官肿大（无关节受累患儿为29%，p=0.05）。中位诊断延迟时间为4周，而无关节受累患儿为2周。有关节受累患儿的5年无事件生存率和总生存率更高：分别为94%对87%（p=0.049），96%对83%（p=0.044）。
有关节受累的ALL很常见（18.5%）。白血病的临床体征不那么突出，但非关节性疼痛应提醒临床医生警惕白血病的可能诊断。与无关节受累的患儿相比，其总生存率和无事件生存率更高。
