title: [Musculoskeletal manifestations as the onset of acute leukemias in childhood].
abstract: OBJECTIVE
  To study the frequency, the clinical features and laboratory exams of patients with musculoskeletal symptoms at the onset of acute leukemia.
  
  
  METHODS
  Retrospective, descriptive study including patients diagnosed with acute leukemia, and treated at the Institute of Pediatric Oncology of UNIFESP, carried out from November 1999 to February 2000. The data on musculoskeletal complaints were obtained from a questionnaire. The medical records were revised in order to get data on the clinical examination and laboratory tests at the beginning of the illness.
  
  
  RESULTS
  Sixty-one children were included in this trial, 93% with acute lymphoid leukemia, and 7% with acute myeloid leukemia. Thirty-eight patients (62%) had musculoskeletal pain at the onset. Arthritis was observed in eight patients. The mean number of involved joints was 2.5 (1-6). The most frequently involved joints were the knees, ankles and elbows. Three patients (4.9%) had normal blood count. Low hemoglobin was reported in 54 patients (88%) (in six patients it was the only hematological abnormality), leukopenia in 14 (22%), leukocytosis in 26 (42%) and low platelet count in 46 (75%).
  
  
  CONCLUSIONS
  The musculoskeletal symptoms are common at the onset of acute leukemia so, malignancy should always be ruled out in patients presenting chronic or acute arthritis or benign limb pain. The laboratory tests may be normal at the onset of the illness, making differential diagnosis more difficult.
authors.affiliation: Dep de Pediatria, Universidade Federal de São Paulo, SP. cassia@vicnet.com.br
authors.forename: Cássia Maria Passarelli Lupoli
authors.initials: CM
authors.lastname: Barbosa
authors.forename: Cláudia
authors.initials: C
authors.lastname: Nakamura
authors.forename: Maria Teresa
authors.initials: MT
authors.lastname: Terreri
authors.forename: Maria Lúcia de Martino
authors.initials: ML
authors.lastname: Lee
authors.forename: Antonio Sergio
authors.initials: AS
authors.lastname: Petrilli
authors.forename: Maria Odete Esteves
authors.initials: MO
authors.lastname: Hilário