Rheumatic manifestations preceding adult acute leukemia: Characteristics and implication in course and prognosis

The manifestations and outcome of adult patients with acute leukemia (AL) w ere examined to study the characteristics of the rheumatological prodrome o f AL and to find whether it is a marker of a distinct clinical and laborato ry course and whether it has any prognostic implication. During a 10-year p eriod, 8/139 (5.8%) of AL patients presented with rheumatic manifestations. The average duration of the arthritis syndrome preceding the diagnosis of AL was 3.25 months. The most common pattern of presentation was a reactive arthritis-like syndrome involving the large joints asymmetrically and assoc iated with low back pain. Distinctive features suggesting a paraneoplastic arthritis were severe pain disproportionate to physical findings, a poor re sponse to conventional antirheumatic treatment, and early significant osteo penia or lytic bone lesions. The epidemiological, clinical and laboratory c haracteristics of patients with or without rheumatic manifestations were co mparable, except for fever on presentation, the presence of transient metab olic derangement following chemotherapy, and the initial average hemoglobin , hematocrit and serum uric acid values. Moreover, the initial outcome of t he two groups was similar, as the early mortality rates were comparable (42 .8% vs. 45% for patients with or without arthritis, respectively). In concl usion, rheumatic syndrome presentation of adult AL is uncommon, and apparen tly has no deleterious effects on initial prognosis. A timely diagnosis req uires an increased awareness to distinctive features.