TITLE:
Acute Lymphoblastic Leukemia Presenting as Systemic Juvenile Idiopathic Arthritis: Experience from Bangladesh
AUTHORS:
Manik Kumar Talukder, Kamrul Laila, Md. Arif Hossain, Md. Shafiqul Islam, Md. Zahidul Islam, Kalyan Benjamin Gomes, Mujammel Haque, Md. Mahbubul Islam, Md. Imnul Islam
KEYWORDS:
ALL, sJIA, Arthritis, Arthralgia, Musculoskeletal
JOURNAL NAME:
Open Journal of Rheumatology and Autoimmune Diseases,
Vol.14 No.1,
January
9,
2024
ABSTRACT: Background: Acute lymphoblastic leukemia (ALL), the most common paediatric
malignancy, is a heterogeneous hematologic disease. ALL patients may present
with isolated and persistent osteo-articular complaints, lower incidence of
hepatomegaly, splenomegaly or lymphadenopathy without clear laboratory
features, and misdiagnosed as systemic juvenile idiopathic arthritis (sJIA). Methods: This was a single center cross sectional study over a period of 4 years. Clinic
laboratory profiles of 39 ALL children were compared with 39 age and sex-matched
sJIA cases. Result: Among 39 ALL patients 89.7% were initially
misdiagnosed as sJIA upon clinical presentation. Majority (66.7%) of ALL
patients had oligo-articular joint involvement. In sJIA, small joints of the hands
were most commonly involved. The total WBC count was significantly higher in
ALL patients (p-value
0.0065). CRP and LDH values between the two groups showed significant
differences (p-value
0.00006 and 0.00001
respectively). Conclusion: The presentation of leukemia with arthralgia
or arthritis makes the diagnosis difficult for the physicians. The diagnosis of
sJIA must be made with caution keeping the possibility of haematological
malignancy in mind.