Jonsson, O.G., Sartain, P., Ducore, J.M. and Buchanan, G.R. (1990) Bone Pain as an Initial Symptom of Childhood Acute Lymphoblastic Leukemia Association with Nearly Normal Hematologic Indexes. The Journal of Pediatrics, 117, 233-237.
https://doi.org/10.1016/S0022-3476(05)80535-9

has been cited by the following article:

• 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.