Manifestations ostéoarticulaires des hémopathies malignes (myélome exclu)

Abstract

Bone involvement is a rare event in lymphomas, except in patients with adult T-cell leukaemia/lymphoma associated with HTLV-I. It is usually characterised by lytic bone lesions located in the metaphysis of long bones or in the axial skeleton. The occurrence of bone lesions reflects a progression of the disease, affecting the prognosis that is related to lymphoma histologic features and staging. Bone lesions may occur in some lymphoproliferative disorders such as LLC or Waldenström’s disease, or in myeloproliferative disorders. They may reflect a progression to a more aggressive disorder with a worse prognosis. Specific bone lesions are rare, and other diagnoses should be entertained, including osteitis or osteomyelitis precipitated by immunodeficiency. Joint involvement in haematological malignancies is most of the time related to infectious complications such as septic arthritis, or to metabolic disorders such as gout. Arthritis related to leukaemic synovitis is a well-recognized complication of leukaemia in children, but acute and chronic leukaemia may also cause arthritis in adults. Vasculitic syndromes, primarily cutaneous leucocytoclastic vasculitis, associated with arthralgias or arthritis, have been described in association with haematological malignancies, especially in hairy cell leukaemia, and may antedate their diagnosis. Haematological malignancies are important to consider in the diagnosis of bone pain or arthritis, and should be suspected particularly in presence of radiological abnormalities, in presence of fever or persistent inflammation in blood tests, as well as in cases of unexplained arthritis, refractory arthritis, or arthritis accompanied by severe pain.