Abstract
A case of juvenile rheumatoid arthritis (JRA) arising after the cessation of the therapy for acute lymphoblastic leukemia (ALL) was reported. A 6-year-old girl was admitted to the hospital because of anorexia, hepatosplenomegaly, lymphadenopathy and severe anemia. The WBC count was 25, 000/mm3 with 92% blasts. Bone marrow examination showed 92.3% blasts which were negative both for peroxidase and PAS. From these data she was diagnosed as having ALL. She was treated with the high-risk ALL protocol 821A from CCLSG. A complete remission was obtained and the schedule of the therapy was completed in April, 1985. She had no joint symptom during the clinical course. In October, 1985, she developed pain and swelling of bilateral foot and knee joints and was admitted to our hospital in December. No evidence of ALL relapse was shown. A definite diagnosis of JRA was obtained by blood examination, arthroscope and synovial biopsy. A test for RA was positive and a high serum level of ANA was demonstrated. The authors are very interested in a possible relationship between ALL and JRA although the precise mechanism (s) remains to be elucidated.
