Background/Purpose: Musculoskeletal (MSK) symptoms are a common presenting complaint in pediatric primary care (estimated prevalence 25-50%) and may be the initial manifestation of cancer in rare cases. An articular involvement has been observed in about 20% of onset leukemias, with pictures that can mimic juvenile idiopathic arthritis (JIA) leading to inappropriate steroid or immunosuppressive therapy and diagnostic delay. The primary objective of this study is to assess the prevalence and features of MSK symptoms at the onset of pediatric tumors. The secondary objective is to identify predictors of malignancy comparing tumors with MSK symptoms at onset and new cases of JIA diagnosed in the same period Methods: The ONCOREUM is a multicenter, observational, cross-sectional study conducted between 2015 and 2018 by 25 Centers of the Italian Association of Pediatric Hematology and Oncology (AIEOP) and 22 Rheumatological Centers of the Italian Society of Pediatrics (SIP). A web based data collection within the AIEOP platform managed by CINECA was performed after local ethics committees approval and written informed consent. We analyzed clinical and laboratory data of patients (pts) < 16 years of age with new diagnosis of tumors or JIA. The data were compare dusing χ² for categorical variables and t-test, Welch’s test, or Mann-Whitney U test for continuous variables. Statistical analysis was performed by the open source statistical software R. Results: We considered eligible 1928 pts: 655 of them were affected by JIA and 1273 by tumor. MSK symptoms at onset were found in 25% of cases of tumors, articular involvement (arthritis and/or arthralgia) in 16% and arthritis in 8% (Fig. 1). An initial rheumatological diagnosis was suspected in 9% (29/322) of tumors with MSK symptoms and in 17% (17/102) of tumors with arthritis at onset. The highest frequency of initial rheumatic suspicion was found in neuroblastoma (5/21), Langerhans histiocytosis (3/16) and leukemia (17/188). The most frequent misdiagnosis were hip synovitis, JIA and reactive arthritis. In this preliminary analysis, we compared the clinical features of pts with tumors and arthritis at onset (102) and pts with JIA (655). We found a difference in the frequency of involvement of specific joints: hip and shoulder were significantly associated with tumors; knee, ankle, wrist and small joints of the hands with JIA (Fig 2). We also found that: monoarthritis, arthralgia, bone pain, back pain, disproportionate pain, night pain, refusal to walk, systemic symptoms and male sex were significantly associated with tumors, while poliarthritis ( > 4 joints), joint swelling and morning stiffness with JIA (Tab.1) Conclusion: MSK symptoms at onset of pediatric tumors were observed in 25% of pts, with joint involvement in more than half of cases. Comparing pts with tumors and arthritis with JIA, we found that some clinical feature are useful in differential diagnosis. It is important to carefully evaluate involvement of specific joint at onset (hip and shoulder), monoarticular involvement, specific characteristic of pain, sex and presence of systemic symptoms since these factors have been shown to be significantly associated with oncologic diagnosis.
Civino, A., Alighieri, G., Rondelli, R., Magni-Manzoni, S., Romano, M., Filocamo, G., Santarelli, F., Ricci, F., Olivieri, A., Pastore, S., Barone, P., Gallizzi, R., Miniaci, A., Marsili, M., Podda, R., Lattanzi, B., Maggio, M., Consolini, R., La Torre, F., Pelagatti, M., Soscia, F., De Fanti, A., Rigante, D., Prete, E., Stabile, G., Roncadori, A., Lepore, L., Conter, V., Pession, A., Ravelli, A., Clinical factors distinguishing between pediatric tumors with arthritis at onset and JIA: preliminary analysis of the ONCOREUM study, Abstract de <<American College of Rheumatology Annual Congress>>, (Atlanta (Georgia), USA, 08-13 November 2019 ), American College of Rheumatology, Atlanta, GA, USA 2019: 2725-2725 [http://hdl.handle.net/10807/145190]
Clinical factors distinguishing between pediatric tumors with arthritis at onset and JIA: preliminary analysis of the ONCOREUM study
Rigante, D;
2019
Abstract
Background/Purpose: Musculoskeletal (MSK) symptoms are a common presenting complaint in pediatric primary care (estimated prevalence 25-50%) and may be the initial manifestation of cancer in rare cases. An articular involvement has been observed in about 20% of onset leukemias, with pictures that can mimic juvenile idiopathic arthritis (JIA) leading to inappropriate steroid or immunosuppressive therapy and diagnostic delay. The primary objective of this study is to assess the prevalence and features of MSK symptoms at the onset of pediatric tumors. The secondary objective is to identify predictors of malignancy comparing tumors with MSK symptoms at onset and new cases of JIA diagnosed in the same period Methods: The ONCOREUM is a multicenter, observational, cross-sectional study conducted between 2015 and 2018 by 25 Centers of the Italian Association of Pediatric Hematology and Oncology (AIEOP) and 22 Rheumatological Centers of the Italian Society of Pediatrics (SIP). A web based data collection within the AIEOP platform managed by CINECA was performed after local ethics committees approval and written informed consent. We analyzed clinical and laboratory data of patients (pts) < 16 years of age with new diagnosis of tumors or JIA. The data were compare dusing χ² for categorical variables and t-test, Welch’s test, or Mann-Whitney U test for continuous variables. Statistical analysis was performed by the open source statistical software R. Results: We considered eligible 1928 pts: 655 of them were affected by JIA and 1273 by tumor. MSK symptoms at onset were found in 25% of cases of tumors, articular involvement (arthritis and/or arthralgia) in 16% and arthritis in 8% (Fig. 1). An initial rheumatological diagnosis was suspected in 9% (29/322) of tumors with MSK symptoms and in 17% (17/102) of tumors with arthritis at onset. The highest frequency of initial rheumatic suspicion was found in neuroblastoma (5/21), Langerhans histiocytosis (3/16) and leukemia (17/188). The most frequent misdiagnosis were hip synovitis, JIA and reactive arthritis. In this preliminary analysis, we compared the clinical features of pts with tumors and arthritis at onset (102) and pts with JIA (655). We found a difference in the frequency of involvement of specific joints: hip and shoulder were significantly associated with tumors; knee, ankle, wrist and small joints of the hands with JIA (Fig 2). We also found that: monoarthritis, arthralgia, bone pain, back pain, disproportionate pain, night pain, refusal to walk, systemic symptoms and male sex were significantly associated with tumors, while poliarthritis ( > 4 joints), joint swelling and morning stiffness with JIA (Tab.1) Conclusion: MSK symptoms at onset of pediatric tumors were observed in 25% of pts, with joint involvement in more than half of cases. Comparing pts with tumors and arthritis with JIA, we found that some clinical feature are useful in differential diagnosis. It is important to carefully evaluate involvement of specific joint at onset (hip and shoulder), monoarticular involvement, specific characteristic of pain, sex and presence of systemic symptoms since these factors have been shown to be significantly associated with oncologic diagnosis.
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