Arthritic presentation of malignancies in children: a retrospective study from two centers in South India

Children with malignancies can present with varied symptoms mimicking rheumatological or orthopedic conditions. Symptoms such as fever, myalgia, arthralgia, and arthritis usually suggest an underlying musculoskeletal condition. However, malignancies in children can also present with such symptoms. The objective of this study was to analyze the clinical and laboratory features of children with malignancies presenting with arthritic manifestations to the paediatric rheumatology clinic and to raise awareness of these presentations among practising physicians. A retrospective case review was carried out in 53 patients who presented to 2 paediatric rheumatology units in 2 tertiary care hospitals in South India. These children presented with musculoskeletal symptoms and had a final diagnosis of malignancy. The median age was 6.1 years with a range from 1 to 15 years and male:female ratio of 1.12:1. The most common presentation was bone pain (75%), followed by fever (53%), polyarthralgia (51%), refusal to bear weight in lower limbs (40%), night pain (40%), and joint swelling (15%). Anemia with Hb < 8 g/dl was observed in 26% of the patients, white cell count (WCC) < 4000 cells/mm³ in 17%, WCC > 12,000 cells/mm³ in 15%, platelets < 150,000/ml in 43%, and erythrocyte sedimentation rate > 20 mm/hr in 77%.The peripheral smear was positive for malignancy in only 40% of the patients. Before referral to tertiary units, 34% were already treated with steroids with a suspected diagnosis of juvenile idiopathic arthritis. Treatment with steroids could mask the symptoms of malignancy and could lead to a delay in diagnosis and a poor outcome.