Department of Pediatrics, Aalborg University Hospital, Reberbansgade 15, 9000, Aalborg, Denmark.
Department of Pediatrics, Aarhus University Hospital, Palle Juul-Jensens Blvd. 99, 8200, Aarhus, Denmark.
Clin Rheumatol. 2018 Sep;37(9):2455-2463. doi: 10.1007/s10067-018-4034-1. Epub 2018 Feb 21.
Acute lymphoblastic leukemia (ALL) is the most common childhood neoplasia and may present with arthralgia and arthritis, with the risk of misdiagnosis and diagnostic delay. We describe in detail arthropathy (arthritis/arthralgia) among children with leukemia as the children's laboratory results, misdiagnosis, and treatment before the diagnosis of ALL and the diagnostic delay. In this retrospective cohort study, we reviewed records of 286 children aged 1-15 years diagnosed with ALL from January 1992 to March 2013. We identified 26 children with arthralgia and 27 children with arthritis. The majority of the children had one or two joints involved (arthralgia 72%, arthritis 42%), and most often hips and knees. Morning stiffness was not reported. Imaging of affected joints was included in the initial workup of 77% of children with ALL and arthropathy, and 66% was abnormal. Misdiagnosis as JIA occurred in 26% and 71% of these children received treatment with intraarticular corticosteroids. The diagnostic delay was 3 weeks longer for the children with arthritis than those with arthralgia (median 54 vs 36 days), primarily as a consequence of a longer first doctor's delay. Compared to the children with arthralgia, the children with arthritis were more often misdiagnosed and treated with intraarticular steroid before the diagnosis of ALL. They also had longer diagnostic delay, primarily as a consequence of a longer first doctor's delay.
急性淋巴细胞白血病 (ALL) 是最常见的儿童肿瘤之一，可表现为关节痛和关节炎，存在误诊和诊断延迟的风险。我们详细描述了白血病儿童的关节病（关节炎/关节痛），包括儿童的实验室结果、误诊、ALL 诊断前的治疗以及诊断延迟。在这项回顾性队列研究中，我们回顾了 1992 年 1 月至 2013 年 3 月期间诊断为 ALL 的 286 名 1-15 岁儿童的记录。我们发现 26 名儿童有关节痛，27 名儿童有关节炎。大多数儿童有一个或两个关节受累（关节痛 72%，关节炎 42%），最常见的受累关节是髋关节和膝关节。未报告晨僵。77%的 ALL 儿童和关节病儿童的初始检查包括受累关节的影像学检查，其中 66%异常。26%的这些儿童被误诊为 JIA，71%的儿童接受了关节内皮质类固醇治疗。关节炎儿童的诊断延迟比关节痛儿童长 3 周（中位数 54 天 vs 36 天），主要是由于首次就诊延迟时间更长。与关节痛儿童相比，关节炎儿童在 ALL 诊断前更常被误诊并接受关节内类固醇治疗。他们也有更长的诊断延迟，主要是由于首次就诊延迟时间更长。
