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SNOWMASS, COLO. — Elevated WBC count is the best indication that a pediatric patient presenting with joint pain has juvenile idiopathic arthritis rather than leukemia, but there are some subtle clinical differences, Patience White, M.D., said at a symposium sponsored by the American College of Rheumatology.
Joint pain in leukemia is usually much more severe than in JIA, and the patient with leukemia may also have bone pain and night pain, said Dr. White, chief of pediatric rheumatology at Children's National Medical Center, Washington.
In the child with JIA, fever will often be high and spiking; fever associated with leukemia tends to be low-grade.
In addition, 90% of patients with systemic onset JIA will have an associated rash, compared with 10% of leukemia patients.
Still, the two can look clinically similar, and it's common for patients with leukemia to end up on a potentially harmful trial course of corticosteroids. In questionable cases, the white blood cell count is most revealing.
Dr. White noted the case of an 8-year-old boy referred to her for possible diagnosis of systemic onset JIA.
The patient had painful arthritis and a maculopapular rash over the trunk, wrist, and ankle and had been experiencing daily fevers for 4 weeks. He had lost 5% of his body weight.
Testing for infection, including blood and urine cultures and a Lyme disease assay, had been negative.
A course of treatment with an NSAID had been unsuccessful and, most importantly, the white blood cell count, at 9,000 cells/μL, was too low to be consistent with a diagnosis of JIA, Dr. White said.
If the patient had JIA, the WBC should have been at least 30,000 cells/μL.
She ordered a bone marrow biopsy rather than initiate a trial of corticosteroid therapy, and the diagnosis of leukemia was confirmed.
SNOWMASS, COLO. — Elevated WBC count is the best indication that a pediatric patient presenting with joint pain has juvenile idiopathic arthritis rather than leukemia, but there are some subtle clinical differences, Patience White, M.D., said at a symposium sponsored by the American College of Rheumatology.
Joint pain in leukemia is usually much more severe than in JIA, and the patient with leukemia may also have bone pain and night pain, said Dr. White, chief of pediatric rheumatology at Children's National Medical Center, Washington.
In the child with JIA, fever will often be high and spiking; fever associated with leukemia tends to be low-grade.
In addition, 90% of patients with systemic onset JIA will have an associated rash, compared with 10% of leukemia patients.
Still, the two can look clinically similar, and it's common for patients with leukemia to end up on a potentially harmful trial course of corticosteroids. In questionable cases, the white blood cell count is most revealing.
Dr. White noted the case of an 8-year-old boy referred to her for possible diagnosis of systemic onset JIA.
The patient had painful arthritis and a maculopapular rash over the trunk, wrist, and ankle and had been experiencing daily fevers for 4 weeks. He had lost 5% of his body weight.
Testing for infection, including blood and urine cultures and a Lyme disease assay, had been negative.
A course of treatment with an NSAID had been unsuccessful and, most importantly, the white blood cell count, at 9,000 cells/μL, was too low to be consistent with a diagnosis of JIA, Dr. White said.
If the patient had JIA, the WBC should have been at least 30,000 cells/μL.
She ordered a bone marrow biopsy rather than initiate a trial of corticosteroid therapy, and the diagnosis of leukemia was confirmed.
SNOWMASS, COLO. — Elevated WBC count is the best indication that a pediatric patient presenting with joint pain has juvenile idiopathic arthritis rather than leukemia, but there are some subtle clinical differences, Patience White, M.D., said at a symposium sponsored by the American College of Rheumatology.
Joint pain in leukemia is usually much more severe than in JIA, and the patient with leukemia may also have bone pain and night pain, said Dr. White, chief of pediatric rheumatology at Children's National Medical Center, Washington.
In the child with JIA, fever will often be high and spiking; fever associated with leukemia tends to be low-grade.
In addition, 90% of patients with systemic onset JIA will have an associated rash, compared with 10% of leukemia patients.
Still, the two can look clinically similar, and it's common for patients with leukemia to end up on a potentially harmful trial course of corticosteroids. In questionable cases, the white blood cell count is most revealing.
Dr. White noted the case of an 8-year-old boy referred to her for possible diagnosis of systemic onset JIA.
The patient had painful arthritis and a maculopapular rash over the trunk, wrist, and ankle and had been experiencing daily fevers for 4 weeks. He had lost 5% of his body weight.
Testing for infection, including blood and urine cultures and a Lyme disease assay, had been negative.
A course of treatment with an NSAID had been unsuccessful and, most importantly, the white blood cell count, at 9,000 cells/μL, was too low to be consistent with a diagnosis of JIA, Dr. White said.
If the patient had JIA, the WBC should have been at least 30,000 cells/μL.
She ordered a bone marrow biopsy rather than initiate a trial of corticosteroid therapy, and the diagnosis of leukemia was confirmed.