Abstract
Children with malignancies can present with varied symptoms mimicking rheumatological or orthopaedic conditions. Symptoms such as fever, myalgia, arthralgia and arthritis usually suggest an underlying musculoskeletal condition. However, malignancies in children can also present with such symptoms. The objective of this study was to analyse the clinical and laboratory features of children with malignancies presenting with arthritic manifestations to the paediatric rheumatology clinic and to raise awareness of this presentations among practising physicians. A retrospective case review was done in 53 patients who presented to 2 paediatric rheumatology units in two tertiary care hospitals in South India. These children presented with musculoskeletal symptoms and had a final diagnosis of malignancy. The median age was 6.1 years with a range from 1-15 years and male: female ratio of 1.12:1. The most common presentation was bone pain (75%) followed by fever (53%), polyarthralgia (51%), refusal to bear weight in lower limbs (40%), night pain (40%) and joint swelling (15%). Anaemia with Hb < 8 g/dl was observed in 26% patients, white cell count (WCC) < 4000 cells/mm3 in 17% , WCC>12000 cells/ mm 3 in 15%, platelets <150,000/ ml in 43% , and erythrocyte sedimentation rate > 20 mm/hr in 77%.The peripheral smear was positive for malignancy in only 40% of patients. Before referral to tertiary units 34% were already treated with steroids with a suspected diagnosis of juvenile idiopathic arthritis. Treatment with steroids could mask the symptoms of malignancy and could lead to a delay in diagnosis and a poor outcome.

Key words: arthritic manifestations, Juvenile idiopathic arthritis, malignancies, steroid treatment