Identifying acute lymphoblastic leukemia mimicking juvenile idiopathic arthritis in children

• DOI: 10.1371/journal.pone.0237530
• Publication Date: 2020-08-11T18:56:11Z
• Authors: Ninna Brix; Steen Rosthøj; Mia Glerup; Henrik Hasle; Troels Herlin
• Keywords: Organomegaly; Juvenile rheumatoid arthritis; Absolute neutrophil count

Objective Acute lymphoblastic leukemia (ALL) may present with arthritis implying the risk of being misdiagnosed as juvenile idiopathic (JIA). The aim this study was to identify predictors for ALL based on clinical and laboratory information. Methods This cross-sectional, retrospective compared presentation results 26 children versus 485 JIA (433 non-systemic, 52 systemic JIA). Using a Bayesian score approach findings were evaluated by calculating odds ratios (OR) lnOR measure diagnostic weight. Results Distinction grounds difficult, even high number joints involved did not exclude ALL. One or more hematologic cell counts low (Hb <10 g/dL, platelet count <100 x 109/L, neutrophil < 1.0 109/L) in 92% ALL, 25% 10% non-systemic JIA. Neutropenia thrombocytopenia had highest ORs 128 (95% CI 43–387) 129 26–638), each giving weight 4. estimated risks 0.2% normal 9%, 67% 100% when one, two three lines affected. Conclusion A simple can serve basic strategy. Children tri- bilinear involvement should be referred bone marrow, those unilinear thorough screen further evidence (organomegaly, ESR, LDH, uric acid, blood smear).