Arthritis in acute leukemia. Clinical and histopathological observations

Abstract

Eight patients had acute leukemia and arthritis. In five the arthritis had no evidenct cause other than the leukemia and three and crystal-induced arthritis. Effusions from both groups of patients were often inflammatory. The average synovial fluid leukocyte count from the 5 effusions attributed to leukemia was 8790/mm3. A synovial needle biopsy specimen from one of these patients showed acute and chronic inflammation but no leukemic infiltration. Bone involvement was suggested by bone pain in only 1 patient. In no case did arthritis persist in the presence of a hematologic remission. In the 3 patients with crystal-induced arthritis the average synovial fluid leukocyte count was 13,000/mm3. There were crystals of monosodium urate in 1 and of calcium pyrophosphate dihydrate in 2 patients. Suspected blast forms were seen in the synovial fluid of only 1 patient, one of those with pseudogout. EM studies of needle biopsy specimens of synovial membrane from leukemic patients with arthritis described herein for the 1st time showed no blast forms, virus-like particles or electron-dense deposits in vessel walls to suggest specific mechanisms for the arthritis.