Authors: L. Šrámková; M. Kynčl; P. Smíšek; V. Vávra; L. Polanecká; P. Sedláček; J. Starý Authors‘ workplace: II. dětská klinika 2. LF UK, FN v Motole, Praha, přednosta doc. MUDr. J. Vavřinec, CSc. Klinika zobrazovacích metod 2. LF UK, FN v Motole, Praha, 2 přednosta doc. MUDr. J. Neuwirth, CSc. Published in: Čes-slov Pediat 2002; (5): 232-235. Category:
Painful bones and joints are one of the frequent symptoms in children with acute lymphoblastic leukaemia (ALL). The X-ray finding varies greatly (osteoporosis, Vogt-Baty strips, foci of osteolysis of osteosclerosis, periostal apposition etc.) and may remind, if the laboratory finding is not marked, of other diseases and lead to diagnostic and subsequently therapeutic errors.The authors evaluated retrospectively anamnestic data in 234 children with acute lymphoblastic leukaemia who were diagnoed in the authors department between January 1990 and December 1999 with regard to the diagnosed affection of bones and joints. Pain as the main symptom of affection of the skeleton was present in 92 children (39.3% ) whereby Pain of the lower extremities was most frequent - 75 children, in preschool children very frequently with restricted mobility and refusal to walk. Less frequently there was Pain in the thoracic region (sternum, clavicle, spine) - 12 children, Pain of the upper extremities, mainly in the region of the shoulder - 2 children and painful jaws - 3 children. Problems with assessment of the correct diagnosis developed mainly in children with a slight change of the haemogram, without marked organomegaly or lymphadenopathy. A total of 29 children (i.e.12.3 % ) from the group were examined or treated for more than on month on account of locomotor disease.The authors confirmed in their group a high percentage of complaints affectiog bones and joints (39.3%) in children with new manifestation of ALL. In tase of such complaints combined with further, frequently non-specific symptoms, it is necessary to include in the differential diagnosis also acute leukaemia. The paper is supplemented by several tase-records which provide evidence that in some children with ALL the symptoms of the locomotor system may precede changes of the haemogram by several months.
Key words: acute lymphoblastic leukaemia, diagnosis, affection of the skeleton
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