title: Osteoarticular manifestations as initial presentation of acute leukemias in children and adolescents in Bahia, Brazil.
abstract: OBJECTIVE
  This study was to determine the prevalence and characteristics of the osteoarticular manifestations on initial clinical presentation of acute leukemias (ALs) on childhood in the state of Bahia, Brazil.
  
  
  METHODS
  This retrospective study assessed the medical records of 406 patients with AL from January 1995 to December 2004.
  
  
  RESULTS
  Acute lymphocytic leukemia (ALL) was diagnosed in 313 (77.1%) patients and acute myeloid leukemia (AML), in 93 (22.9%) patients, including 241 males (59.4%) and 165 females (40.6%). Age ranged from 9 months to 15 years (average: 6.18 y). The most common presenting features were fever (18.5%), musculoskeletal diffuse tenderness (15.0%), pallor (11.4%), and leg tenderness (5.7%). Prior referral to our center, the most frequent initial diagnosis was anemia (15.8%), leukemia (15.0%), amygdalitis (3.7%), and rheumatic fever (2.7%). Osteoarticular manifestations were found on 54.7% of the patients with AL, with a higher frequency among patients between 1 and 9 years of age (58.7%, P=0.0007). The presence of joint tenderness (16.2% in ALLx5.4% in AML), arthritis (26.6% in ALLx9.7 in AML), bone tenderness (26.1% in ALLx16.1% in AML), limb tenderness (49.5% in ALLx25.8% in AML), and antalgic gait (32.8% in ALLx9.7% in AML) had higher prevalence on ALL. The large joints, chiefly the knees (10.6%), ankles (9.4%), elbows (4.4%), and shoulders (3.6%) were more often affected.
  
  
  CONCLUSIONS
  AL should be considered on the differential diagnosis of osteoarticular symptoms of unknown etiology in children.
authors.affiliation: Pediatric Rheumatology Unit at Hospital São Rafael, Fundação Monte Tabor, and Pediatric Gastroenterology and Hepatology Service of Federal University of Bahia, Bahian Medical and Public Health School, Salvador, Bahia, Brazil. trobazzi@gmail.com
authors.forename: Teresa Cristina Martins Vicente
authors.initials: TC
authors.lastname: Robazzi
authors.forename: José H S
authors.initials: JH
authors.lastname: Barreto
authors.forename: Luciana R
authors.initials: LR
authors.lastname: Silva
authors.forename: Mittermayer B
authors.initials: MB
authors.lastname: Santiago
authors.forename: Núbia
authors.initials: N
authors.lastname: Mendonça
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D001938:Brazil; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D007951:Leukemia, Myeloid / Q000150:complications / Q000175:diagnosis*; D008297:Male; D010003:Osteoarthritis / Q000175:diagnosis* / Q000209:etiology; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000150:complications / Q000175:diagnosis*