Pediatric Rheumatology Online Journal → June 2003 → Systemic Onset Arthritis → Abstract #16

DIFFERENTIATION OF NEUROBLASTOMA (NB) FROM SYSTEMIC JUVENILE RHEUMATOID ARTHRITIS (sJRA) AT THE ONSET OF DISEASE

G. R. Sarver,¹ B. E. Ostrov,¹ D. R. Ungar,² B. P. Groh.¹

¹Department of Pediatric Rheumatology, Hershey Medical Center, Pennsylvania State University, Hershey, PA; ²Department of Pediatric Oncology, Hershey Medical Center, Pennsylvania State University, Hershey, PA

Objective:Children with NB may present with musculoskeletal (M/S) symptoms which may mimic sJRA.We reviewed clinical and lab parameters that may aid in early recognition of NB. Methods:Subjects were identified from a ten year retrospective chart review from 1992-2002 of children receiving care at Hershey Medical Center (HMC) Pediatric Rheumatology and Oncology Clinics. Ten patients with NB and M/S symptoms were identified. Twenty sJRA patients were age selected for comparison. Presenting signs, symptoms and labs were compared. Results:Age ranges were 2 mos-11 yrs with median age of 3 yrs, and 1-11 yrs with a median age of 4 yrs for the NB and sJRA groups respectively. The male:female ratio was 1:1. Significant clinical differences were the higher frequency of weakness/ataxia in NB (p=0.0562) and fever in sJRA (p=0.0004). There were no abdominal masses present in either group. Nocturnal bone pain and hepatosplenomegally were not prevalent in either group. The only differentiating lab feature was a WBC count 15 in the sJRA group (p=0.0072). Other lab abnormalities (platelet count, ferritin, and LFTs) were more common in sJRA, but not statistically significant.Discussion:We identified WBC, fever and neurological symptoms as statistically different between sJRA and NB. There were trends towards differences in LFTs, Ferritin level, and Platelet counts which a larger analysis may substantiate. While this study did not find bone and/or back pain as distinguishing features of NB, these symptoms are prevalent in leukemia, helping distinguish that malignancy from sJRA (JPediatrics,1993;122:595). Conclusion:A clinical composite of symptoms, exam and lab findings should aid physicians in distinguishing primary M/S diseases from malignancy. Atypical presentations of sJRA (lack of elevated WBC or platelet count, or presence of neurological changes and/or back pain) should heighten suspicion of malignancy. Early attention to findings uncharacteristic of sJRA may expedite diagnosis of NB and other malignancies.