The clinical features of 19 patients who had
arthritis and
leukemia were reviewed and compared with those without
arthritis. There was leukemic
arthritis (characterized by absence of other evident causes and response to
chemotherapy) in 14,
septic arthritis in 4, and
hemarthrosis in 1. Among those with leukemic
arthritis, there was acute
leukemia in 11 and chronic
leukemia in 3. The
arthritis presented before, simultaneously with, and after the diagnosis of
leukemia in 5, 4, and 5 cases, respectively. Acute symmetrical
polyarthritis mimicking rheumatoid was the most common presentation. The knee, wrist, and ankle were most commonly involved. Adegree of
pain, which was out of proportion to the degree of
inflammation, could be seen occasionally. Synovial fluid blast cells were identified in 33% of cases. The leukemic
arthritis responded well to
chemotherapy.
Septic arthritis was an initial presentation of
leukemia in 2 patients. There was no significant difference in hematologic parameters or in mortality rate between those with and without
arthritis. In conclusion, symmetric
polyarthritis mimicking rheumatoid and
septic arthritis could be an initial presentation of leukemic
arthritis. One should have a high index of suspicion in patients with acute
arthritis, especially if there is already
anemia and
pain is out of proportion to swelling.