From the Guidelines
Yes, Acute Myeloid Myelomonocytic Leukemia (AMML) can present with rheumatic symptoms, and clinicians should consider it in the differential diagnosis when evaluating patients with new-onset rheumatic symptoms, especially if accompanied by abnormal blood counts or unusual constitutional symptoms. Although the provided study 1 focuses on the diagnosis and management of Acute Myeloid Leukemia (AML) and Blastic Plasmacytoid Dendritic Cell Neoplasm (BPDCN), it highlights the complexity and heterogeneity of myeloid malignancies, which can sometimes present with non-specific symptoms, including rheumatic manifestations. Some key points to consider in the context of AMML presenting with rheumatic symptoms include:
- Joint pain, swelling, and stiffness that can mimic rheumatoid arthritis or other rheumatic conditions
- Infiltration of leukemic cells into the synovial tissues or periosteum
- Release of inflammatory cytokines by the abnormal myelomonocytic cells
- Common rheumatic manifestations such as polyarthritis, bone pain, and myalgias
- The potential for these symptoms to precede the diagnosis of leukemia by weeks or months, leading to initial misdiagnosis as a primary rheumatologic disorder. When evaluating such patients, essential diagnostic tests include complete blood count with differential, peripheral blood smear, and bone marrow examination, as these can help identify the underlying cause of the rheumatic symptoms and lead to a timely diagnosis and appropriate treatment of AMML, as suggested by the most recent guidelines 1.
From the Research
Presentation of Acute Myeloid Myelomonocytic Leukemia (AMML)
- AMML can present with various symptoms, but the provided studies do not directly address whether it can present with rheumatic symptoms.
- However, a study 2 discusses the association of rheumatic disease with malignancy, paraneoplastic syndromes with rheumatic manifestations, and chemotherapeutic agents related to rheumatic syndromes, suggesting a possible link between rheumatic symptoms and hematological malignancies.
Rheumatic Manifestations of Malignancy
- A review 2 highlights the importance of considering malignancy in patients presenting with rheumatic symptoms, as some rheumatic diseases can be associated with an increased risk of malignancy.
- Another study 3 discusses the hematological manifestations of rheumatic diseases, including cytopenias, Felty's syndrome, and autoimmune hemolytic anemia, which can sometimes be the first sign of a rheumatic disease.
Acute Myeloid Leukemia (AML) and Rheumatic Symptoms
- While the provided studies do not specifically address AMML presenting with rheumatic symptoms, a study 4 discusses the symptoms of AML, which can include pancytopenia with corresponding symptoms such as anemia, thrombo- and granulocytopenia.
- It is possible that some patients with AML or AMML may experience rheumatic symptoms, but this is not directly addressed in the provided studies 5, 6, 4.