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Civino A, Alighieri G, Prete E, Caroleo AM, Magni-Manzoni S, Vinti L, Romano M, Santoro N, Filocamo G, Belotti T, Santarelli F, Gorio C, Ricci F, Colombini A, Pastore S, Cesaro S, Barone P, Verzegnassi F, Olivieri AN, Ficara M, Miniaci A, Russo G, Gallizzi R, Pericoli R, Breda L, Mura R, Podda RA, Onofrillo D, Lattanzi B, Tirtei E, Maggio MC, De Santis R, Consolini R, Arlotta A, La Torre F, Mainardi C, Pelagatti MA, Coassin E, Capolsini I, Burnelli R, Tornesello A, Soscia F, De Fanti A, Rigante D, Pizzato C, De Fusco C, Abate ME, Roncadori A, Rossi E, Stabile G, Biondi A, Lepore L, Conter V, Rondelli R, Pession A, Ravelli A. Musculoskeletal manifestations of childhood cancer and differential diagnosis with juvenile idiopathic arthritis (ONCOREUM): a multicentre, cross-sectional study. Lancet Rheumatol 2021; 3:e507-e516. [PMID: 38279403 DOI: 10.1016/s2665-9913(21)00086-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 03/03/2021] [Accepted: 03/11/2021] [Indexed: 10/08/2023]
Abstract
BACKGROUND Presenting symptoms of childhood cancers might mimic those of rheumatic diseases. However, the evidence available to guide differential diagnosis remains scarce. Preventing wrong or delayed diagnosis is therefore important to avoid incorrect administration of glucocorticoid or immunosuppressive therapy and worsening of prognosis. As such, we aimed to assess the prevalence and characteristics of presenting musculoskeletal manifestations in patients at cancer onset and to identify the factors that differentiate childhood malignancies with arthropathy from juvenile idiopathic arthritis. METHODS We did a multicentre, cross-sectional study at 25 paediatric haemato-oncology centres and 22 paediatric rheumatology centres in Italy. We prospectively recruited patients who were younger than 16 years that were newly diagnosed with cancer or juvenile idiopathic arthritis. We excluded patients with glucocorticoid pre-treatment (>1 mg/kg per day of oral prednisone or equivalent for ≥2 consecutive weeks). We collected data for patients with a new diagnosis of cancer or juvenile idiopathic arthritis using an electronic case report form on a web-based platform powered by the Cineca Interuniversity Consortium. The primary outcome was to describe the frequency and characteristics of musculoskeletal manifestations at cancer onset; and the secondary outcome was to identify factors that could discriminate malignancies presenting with arthropathy, with or without other musculoskeletal symptoms, from juvenile idiopathic arthritis using multivariable logistic regression analysis. FINDINGS Between May 1, 2015, and May 31, 2018, 1957 patients were eligible, of which 1277 (65%) had cancer and 680 (35%) had juvenile idiopathic arthritis. Musculoskeletal symptoms occurred in 324 (25% [95% CI 23·0-27·8]) of 1277 patients with cancer, of whom 207 had arthropathy. Patients with malignant bone tumours had the highest frequency of musculoskeletal symptoms (53 [80%] of 66), followed by patients with Langerhans histiocytosis (16 [47%] of 34), leukaemia (189 [32%] of 582), soft-tissue sarcomas (16 [24%] of 68), and neuroblastoma (21 [19%] of 109). In the 324 patients with cancer and musculoskeletal symptoms, the most common complaints were joint pain (199 [61%]), followed by limb bone pain (112 [35%]). Joint involvement had a prevalent monoarticular pattern (100 [48%] of 207) and oligoarticular pattern (86 [42%] had 2-4 joints involved and 20 [10%] had >4 joints involved), with the most frequently involved joints being the hip (88 [43%] of 207) and knee (81 [39%]). On multivariable analysis, limb bone pain was the independent variable most strongly associated with cancer (odds ratio [OR] 87·80 [95% CI 18·89-408·12]), followed by weight loss (59·88 [6·34-565·53]), thrombocytopenia (12·67 [2·40-66·92]), monoarticular involvement (11·30 [4·09-31·19]), hip involvement (3·30 [1·13-9·61]), and male sex (2·40 [1·03-5·58]). Factors independently associated with juvenile idiopathic arthritis were morning stiffness (OR 0·04 [95% CI 0·01-0·20]), joint swelling (0·03 [0·01-0·09]), and involvement of the small hand joints (0·02 [0-1·05]). INTERPRETATION Our study provides detailed information about presenting musculoskeletal manifestations of childhood cancers and highlights the clinical and laboratory features that are most helpful in the differential diagnosis with juvenile idiopathic arthritis. FUNDING Associazione Lorenzo Risolo.
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Affiliation(s)
- Adele Civino
- Unità di Reumatologia e Immunologia Pediatrica, Ospedale Vito Fazzi, Lecce, Italy.
| | - Giovanni Alighieri
- Unità di Pediatra-UTIN, Azienda Ospedaliera Cardinale G Panico, Tricase, Italy
| | - Eleonora Prete
- Dipartimento di Ematologia, Azienda Ospedaliera Cardinale G Panico, Tricase, Italy
| | - Anna Maria Caroleo
- Dipartimento di Oncoematologia Pediatrica, IRCCS Istituto Giannina Gaslini, Genova, Italy
| | | | - Luciana Vinti
- Dipartimento di Oncoematologia Pediatrica, Ospedale Pediatrico Bambino Gesù IRCCS, Roma, Italy
| | - Micol Romano
- Divisione di Reumatologia, ASST G Pini-CTO, Milano, Italy
| | - Nicola Santoro
- Oncoematologia Pediatrica, Azienda Ospedaliero Universitaria Consorziale Policlinico di Bari, Bari, Italy
| | - Giovanni Filocamo
- Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milano, Italy
| | - Tamara Belotti
- Clinica Pediatrica, Oncologia ed Ematologia Pediatrica Lalla Seràgnoli, Policlinico Sant'Orsola Malpighi, Bologna, Italy
| | - Francesca Santarelli
- Dipartimento di Pediatria, Ospedale Pediatrico Regina Margherita, AOU Città della Salute e della Scienza di Torino, Torino, Italy
| | - Chiara Gorio
- Unità di Oncoematologia Pediatrica e TMO, Spedali Civili, Brescia, Italy
| | | | - Antonella Colombini
- Unità di Oncoematologia Pediatrica, Fondazione MBBM/AO San Gerardo Clinica Pediatrica Universitaria, Monza, Italy
| | - Serena Pastore
- Dipartimento di Pediatria, Azienda Ospedaliera-Universitaria Integrata, Verona, Italy
| | - Simone Cesaro
- Oncoematologia Pediatrica, Dipartimento di Assistenza Integrata Materno Infantile, Azienda Ospedaliera-Universitaria Integrata, Verona, Italy
| | - Patrizia Barone
- Dipartimento di Pediatria, Azienda Ospedaliero Universitaria, Policlinico di Catania, Catania, Italy
| | - Federico Verzegnassi
- Unità di Oncoematologia Pediatrica, IRCCS Materno Infantile Burlo Garofolo, Trieste, Italy
| | - Alma Nunzia Olivieri
- Dipartimento della donna, del bambino e di chirurgia generale e specialistica, Università degli Studi della Campania Luigi Vanvitelli, Napoli, Italy
| | - Monica Ficara
- Divisione di Oncoematologia Pediatrica, Ospedale Policlinico, Modena, Italy
| | - Angela Miniaci
- Clinica Pediatrica, Policlinico Sant'Orsola Malpighi, Bologna, Italy
| | - Giovanna Russo
- Unità di Oncoematologia Pediatrica, Dipartimento di Medicina Clinica e Sperimentale, Università di Catania, Italy
| | - Romina Gallizzi
- Unità di Pediatria, Azienda Ospedaliera Universitaria Gaetano Martino, Messina, Italy
| | | | - Luciana Breda
- Reumatologia Pediatrica, Università di Chieti, Italy
| | - Rossella Mura
- Oncoematologia Pediatrica, Azienda Ospedaliera Brotzu, Cagliari, Italy
| | | | - Daniela Onofrillo
- Unità di Oncoematologia Pediatrica, Dipartimento di Ematologia, Ospedale di Pescara, Italy
| | - Bianca Lattanzi
- Azienda Ospedaliera Universitaria, Ospedale Pediatrico G Salesi, Ancona, Italy
| | - Elisa Tirtei
- SC Oncologia Pediatrica, Ospedale Infantile Regina Margherita, AOU Città della Salute e della scienza, Università di Torino, Italy
| | | | - Raffaela De Santis
- Dipartimento di Pediatria, Unità di Oncoematologia Pediatrica, Ospedale Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
| | - Rita Consolini
- Dipartimento di Pediatria, Università di Pisa, Pisa, Italy
| | - Annalisa Arlotta
- Unità di Oncoematologia Pediatrica, Azienda Ospedaliero Universitaria di Parma, Italy
| | - Francesco La Torre
- Reumatologia Pediatrica, Azienda Ospedaliero Universitaria Consorziale Policlinico di Bari-Ospedale Pediatrico Giovanni XXIII, Bari, Italy
| | - Chiara Mainardi
- DIDAS Salute della Donna e del Bambino, Divisione di Oncoematologia Pediatrica e Trapianto di cellule ematopoietiche, Azienda Ospedaliera Universitaria di Padova, Padova, Italy
| | | | - Elisa Coassin
- SOSD Oncologia del Giovane e Radioterapia Pediatrica, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Aviano, Italy
| | - Ilaria Capolsini
- A O U S M Della Misericordia, Oncoematologia Pediatrica con TCSE, Perugia, Italy
| | - Roberta Burnelli
- Unità di Oncoematologia Pediatrica, Azienda Ospedaliero Universitaria Sant'Anna di Ferrara, Cona, Italy
| | | | - Francesca Soscia
- Unità di Pediatria, Ospedale Santa Maria della Stella, Orvieto, Italy
| | | | - Donato Rigante
- Dipartimento di Scienze della Vita e Sanità Pubblica, Fondazione Policlinico Universitario A Gemelli IRCCS, Roma, Italy; Università Cattolica Sacro Cuore, Roma, Italy
| | | | - Carmela De Fusco
- Dipartimento di Oncologia Pediatrica, AORN Santobono-Pausilipon, Napoli, Italy
| | | | - Andrea Roncadori
- Healthcare Administration, IRCCS-Istituto Romagnolo per lo Studio dei Tumori Dino Amadori-IRST, Meldola, FC, Italy
| | - Elisa Rossi
- Consorzio Interuniversitario Cineca, Casalecchio di Reno, Italy
| | - Giulia Stabile
- Consorzio Interuniversitario Cineca, Casalecchio di Reno, Italy
| | - Andrea Biondi
- Unità di Oncoematologia Pediatrica, Fondazione MBBM/AO San Gerardo Clinica Pediatrica Universitaria, Monza, Italy
| | - Loredana Lepore
- Dipartimento di Pediatria, Azienda Ospedaliera-Universitaria Integrata, Verona, Italy
| | - Valentino Conter
- Unità di Oncoematologia Pediatrica, Fondazione MBBM/AO San Gerardo Clinica Pediatrica Universitaria, Monza, Italy
| | - Roberto Rondelli
- Clinica Pediatrica, Oncologia ed Ematologia Pediatrica Lalla Seràgnoli, Policlinico Sant'Orsola Malpighi, Bologna, Italy
| | - Andrea Pession
- Clinica Pediatrica, Oncologia ed Ematologia Pediatrica Lalla Seràgnoli, Policlinico Sant'Orsola Malpighi, Bologna, Italy
| | - Angelo Ravelli
- Dipartimento di Neuroscienze, Riabilitazione, Oftalmologia, Genetica e Scienze Materno-Infantili (DiNOGMI), Università degli Studi di Genova, Genova, Italy; Clinica Pediatrica e Reumatologia, IRCCS Istituto Giannina Gaslini, Genova, Italy; Department of Pediatric Rheumatology, Sechenov First Moscow State Medical University, Moscow, Russian
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Consolaro A, Bovis F, Pistorio A, Cimaz R, De Benedetti F, Miniaci A, Corona F, Gerloni V, Martino S, Pastore S, Barone P, Pieropan S, Cortis E, Podda RA, Gallizzi R, Civino A, Torre FL, Rigante D, Consolini R, Maggio MC, Magni-Manzoni S, Perfetti F, Filocamo G, Toppino C, Licciardi F, Garrone M, Scala S, Patrone E, Tonelli M, Tani D, Ravelli A, Martini A, Ruperto N. The Italian version of the Juvenile Arthritis Multidimensional Assessment Report (JAMAR). Rheumatol Int 2018; 38:251-258. [PMID: 29637324 PMCID: PMC5893696 DOI: 10.1007/s00296-018-3960-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Accepted: 01/11/2018] [Indexed: 11/28/2022]
Abstract
The Juvenile Arthritis Multidimensional Assessment Report (JAMAR) is a new parent/patient reported outcome measure that enables a thorough assessment of the disease status in children with juvenile idiopathic arthritis (JIA). We report the results of the cross-cultural adaptation and validation of the parent and patient versions of the JAMAR in the Italian language.The reading comprehension of the questionnaire was tested in 10 JIA parents and patients. Each participating centre was asked to collect demographic, clinical data and the JAMAR in 100 consecutive JIA patients or all consecutive patients seen in a 6-month period and to administer the JAMAR to 100 healthy children and their parents.The statistical validation phase explored descriptive statistics and the psychometric issues of the JAMAR: the 3 Likert assumptions, floor/ceiling effects, internal consistency, Cronbach's alpha, interscale correlations, test-retest reliability, and construct validity (convergent and discriminant validity).A total of 1296 JIA patients (7.2% systemic, 59.5% oligoarticular, 21.4% RF negative polyarthritis, 11.9% other categories) and 100 healthy children, were enrolled in 18 centres. The JAMAR components discriminated well healthy subjects from JIA patients except for the Health Related Quality of Life (HRQoL) Psychosocial Health (PsH) subscales. All JAMAR components revealed good psychometric performances.In conclusion, the Italian version of the JAMAR is a valid tool for the assessment of children with JIA and is suitable for use both in routine clinical practice and clinical research.
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Affiliation(s)
- Alessandro Consolaro
- Clinica Pediatrica e Reumatologia, Paediatric Rheumatology International Trials Organisation (PRINTO), Istituto Giannina Gaslini, Via Gaslini 5, 16147, Genoa, Italy. .,Dipartimento di Pediatria, Università di Genova, Genoa, Italy.
| | - Francesca Bovis
- Clinica Pediatrica e Reumatologia, Paediatric Rheumatology International Trials Organisation (PRINTO), Istituto Giannina Gaslini, Via Gaslini 5, 16147, Genoa, Italy
| | - Angela Pistorio
- Servizio di Epidemiologia e Biostatistica, Istituto Giannina Gaslini, Genoa, Italy
| | - Rolando Cimaz
- Dipartimento di Pediatria, Azienda Ospedaliero-Universitaria Meyer, Florence, Italy
| | | | - Angela Miniaci
- Salute della Donna, del Bambino e dell'Adolescente-Padiglione 16 Ambulatorio di reumatologia, Azienda Ospedaliero-Universitaria S.Orsola-Malpighi, Bologna, Italy
| | - Fabrizia Corona
- Clinica Pediatrica II De Marchi, Fondazione IRCCS Ca' Granda-Ospedale Maggiore Policlinico, Milan, Italy
| | - Valeria Gerloni
- Divisione di Reumatologia, Istituto Gaetano Pini, Milan, Italy
| | - Silvana Martino
- Clinica Pediatrica, Paediatrics Departments, Università di Torino, Turin, Italy
| | - Serena Pastore
- Scienze della Riproduzione e dello Sviluppo, IRCCS Burlo Garofolo, Trieste, Italy
| | - Patrizia Barone
- Clinica Pediatrica, Azienda Policlinico Università di Catania, Catania, Italy
| | | | - Elisabetta Cortis
- Struttura Complessa Pediatria, Ospedale Santa Maria Della Stella, Località Ciconia-Orvieto, Terni, Italy
| | - Rosa Anna Podda
- Clinica e Biologia dell'età evolutiva, Ospedale Regionale Microcitemia-II Clinica Pediatrica, Cagliari, Italy
| | - Romina Gallizzi
- Department of Human Pathology in Adulthood and Childhood, University of Messina, Messina, Italy
| | - Adele Civino
- Pediatria, Azienda Ospedaliera Cardinale G. Panico, Tricase, LE, Italy
| | - Francesco La Torre
- Centro Regionale-HUB-di Reumatologia Pediatrica, Ospedale Antonio Perrino, Brindisi, Italy
| | - Donato Rigante
- Pediatria, Università Cattolica Sacro Cuore, Roma, Italy
| | - Rita Consolini
- Pediatria, Ospedale Santa Chiara, Università di Pisa, Pisa, Italy
| | - Maria Cristina Maggio
- University Department Pro.Sa.M.I. "G. D'Alessandro", University of Palermo, Palermo, Italy
| | | | - Francesca Perfetti
- Division of Rheumatology, IRCCS Ospedale Pediatrico Bambino Gesù, Rome, Italy
| | - Giovanni Filocamo
- Clinica Pediatrica II De Marchi, Fondazione IRCCS Ca' Granda-Ospedale Maggiore Policlinico, Milan, Italy
| | - Claudia Toppino
- Clinica Pediatrica, Paediatrics Departments, Università di Torino, Turin, Italy
| | - Francesco Licciardi
- Clinica Pediatrica, Paediatrics Departments, Università di Torino, Turin, Italy
| | - Marco Garrone
- Clinica Pediatrica e Reumatologia, Paediatric Rheumatology International Trials Organisation (PRINTO), Istituto Giannina Gaslini, Via Gaslini 5, 16147, Genoa, Italy
| | - Silvia Scala
- Clinica Pediatrica e Reumatologia, Paediatric Rheumatology International Trials Organisation (PRINTO), Istituto Giannina Gaslini, Via Gaslini 5, 16147, Genoa, Italy
| | - Elisa Patrone
- Clinica Pediatrica e Reumatologia, Paediatric Rheumatology International Trials Organisation (PRINTO), Istituto Giannina Gaslini, Via Gaslini 5, 16147, Genoa, Italy
| | - Monica Tonelli
- Clinica Pediatrica e Reumatologia, Paediatric Rheumatology International Trials Organisation (PRINTO), Istituto Giannina Gaslini, Via Gaslini 5, 16147, Genoa, Italy
| | - Daniela Tani
- Clinica Pediatrica e Reumatologia, Paediatric Rheumatology International Trials Organisation (PRINTO), Istituto Giannina Gaslini, Via Gaslini 5, 16147, Genoa, Italy
| | - Angelo Ravelli
- Clinica Pediatrica e Reumatologia, Paediatric Rheumatology International Trials Organisation (PRINTO), Istituto Giannina Gaslini, Via Gaslini 5, 16147, Genoa, Italy.,Dipartimento di Pediatria, Università di Genova, Genoa, Italy
| | - Alberto Martini
- Direzione Scientifica, Istituto Giannina Gaslini, Via Gaslini 5, 16147, Genoa, Italy
| | - Nicolino Ruperto
- Clinica Pediatrica e Reumatologia, Paediatric Rheumatology International Trials Organisation (PRINTO), Istituto Giannina Gaslini, Via Gaslini 5, 16147, Genoa, Italy.
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