Rheumatoid arthritis in a sickle cell patient: a dangerous association? (original) (raw)
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Non-gouty arthritis in sickle cell disease: report of 37 consecutive cases
Annals of the Rheumatic Diseases, 1984
Arthritis in association with sickle cell disease was seen in 37 patients in a 2½/2-year period. Cases of gout and of avascular necrosis of the femoral head were excluded. In 12 patients a non-inflammatory effusion occurred during the course of a painful crisis, in 12 patients an ankle effusion occurred in association with spontaneous development or deterioration of leg ulceration, and in 13 patients there was a group of miscellaneous arthritides. Ankle arthritis with leg ulceration has not been previously recognised, and its association with spontaneous ulceration, which is presumed to have a vaso-occlusive origin, is compatible with ischaemic synovial damage. The aetiology may therefore be similar to that believed to account for effusions in association with the painful crisis.
Rheumatology (Sunnyvale, Calif.), 2017
The advent of hydroxyurea and advanced medical care, including immunizations has led to improved survival among patients with Sickle Cell Disease (SCD). This prolonged survival however, introduces a chronic inflammatory disorder, Rheumatoid Arthritis (RA), which presents at a relatively older age and is rarely reported among SCD patients. In this review, we highlight the epidemiological association of SCD-RA and discuss the underlying common pathogenetic mechanisms, such as endothelial dysfunction, the role of inflammatory cytokines and oxidative stress. We also point to the difficulties in ascertaining the clinical diagnosis of RA in SCD patients. Finally, we provide rationale for therapeutic options available for RA and the challenges in the management of these patients with agents that are known to increase the risk of infection and immunosuppression such as steroids, disease modifying anti-rheumatic drugs and biologics.
Journal of Ancient Diseases & Preventive Remedies
Objectives: Rheumatoid arthritis (RA) has been rarely reported in association with sickle cell disease (SCD). Our study aimed to estimate the prevalence of RA in SCD population and to describe the clinical characteristics of RA associated with SCD. Methods: Retrospective chart review of SCD and RA patients followed at 2 large urban hospitals. Seven RA/SCD patients were identified and compared to age and sex matched cohort of SCD only and of RA only group. All patients were Black. Results: There were 739 SCD cases, seven (0.94%) met ACR criteria for RA (SCD-RA), 411 cases were RA only group. Mean age was significantly higher in SCD-RA compared to the entire population of SCD and RA (41.7 ± 3.9 (± SEM) vs. 33.26 ± 0.47, vs. 61.39 ± 0.79, p<0.01). SCD-RA patients had lower hemoglobin (g/dl) when compared to the age and sex matched SCD or RA only patients (7.4 ± 0.49 vs. 8.3 ± 0.60 vs. 11 ± 0.59, p <0.01) respectively. There were no significant differences in laboratory and treatment approach between SCD-RA and RA only groups, except for the radiographic evidence of periarticular osteopenia and greater difficulty in the activities of daily living (ADL) among SCD-RA cohort, compared to the age and sex matched RA cohort (p=0.01) Conclusion: In contrast to older reports, the prevalence of RA among SCD patients in our study (0.94%) was similar to that reported in the general population (0.5-1%) and was to be associated with difficulty in ADL and periarticular osteopenia. Since RA manifests at an older age, our reported prevalence is likely explainable by improved survival of SCD patients due to enhanced medical care and the advent of hydroxyurea as a major therapeutic breakthrough for SCD.
Musculoskeletal Manifestations of Sickle Cell Disease: A Review
Cureus, 2015
Sickle cell disease (SCD) is an inherited disorder of abnormal haemoglobin commonly encountered in the West African sub-region. It has varied osteoarticular and non-osseous complications that mimic some surgical conditions. The most common orthopaedic complications include avascular necrosis, osteomyelitis, septic arthritis, etc. A cautious and painstaking evaluation is required in handling these patients. Acute care and anaesthetic precautions are vital in ensuring an uneventful postoperative period.
Orthopaedic complications associated with sickle-cell disease
Acta orthopaedica Belgica, 2006
Sickle cell disease is the most frequent haemoglobinopathy in the world. It affects mostly African descent, but is also present in whites in Greece, Turkey, Italy and India. The responsible gene is autosomal co-dominant and only individuals homozygous for the gene are symptomatic. The condition is characterised by haemolytic anaemia crises and cardio-pulmonary, digestive, neurological, ocular and osteo-articular manifestations. Osteo-articular complications are frequent and may compromise harmonious growth. This retrospective study reports the osteo-articular complications associated with sickle-cell disease encountered in our institution from 1975 to 2004. Orthopaedic complications were reported in 79 patients out of 325 who were followed with sickle-cell disease.
Temporomandibular joint arthritis in sickle cell disease: a case report
Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology, 2013
We report a rare case of aseptic arthritis in the temporomandibular joint of a patient with sickle cell anemia. A 22year-old woman with sickle cell disease, in the 18th week of gestation, was referred by her hematologist to investigate a sudden mouth opening limitation and severe pain on her left cheek. The patient received a standard pain assessment protocol, clinical examination, and complementary exams (complete blood count, hemoglobin electrophoresis, blood solubility test, panoramic radiograph, and magnetic resonance imaging [MRI]). The blood results were consistent with a sickle cell crisis and the MRI showed an inflammatory process around the left temporomandibular joint. Treatment with opioid analgesics and blood transfusion provided good results. Sickle cell anemia is a disease that can cause arthritis of the temporomandibular joint, and although it is rare, clinicians should be attentive to the differential diagnosis in patients with this disease. (Oral Surg Oral Med Oral Pathol Oral Radiol 2013;115:e31-e35) Competing interests. There are no competing financial interests.
Juvenile idiopathic arthritis coexisting with sickle cell disease: two case reports
Case Reports, 2011
Two cases of coexisting juvenile idiopathic arthritis (JIA) and sickle cell disease (ages 7 and 17) are presented. The diagnoses of JIA were delayed for years because of the similarity of presentations in the two conditions. Both cases had been treated with non-steroidal antiinfl ammatory drugs for years. Both had positive rheumatoid factor, and elevated erythrocyte sedimentation rate (ESR) while one of the patients had elevated serum ferritin and anticyclic citrullinated protein. Radiology showed marked arthritic changes with presence of avascular necrosis in a patient's head of femur. Both cases were treated with etanercept for 6 months each, as well as methotrexate. At the end of 6 months, the joint count for pains and swelling were done as well as ESR.
Osteoarticular disorders in sickle cell disease
International Journal Of Community Medicine And Public Health
Different organs can be affected secondary to sickle cell disease, including the central nervous system, kidneys, gastrointestinal tract, respiratory system, cardiovascular system, bone, and joints. This can lead to increased morbidity and mortality events among the affected patients. Osteoarticular complications represent a severe set of events for patients with sickle cell disease. These complications might include gouty, septic, juvenile, and erosive arthritis, dactylitis, bone infarction, and osteomyelitis. These are the most common complications reported in the literature, and some case reports even reported other types of complications that develop secondary to the previously mentioned ones. Adequate diagnosis might be challenging in some cases. Therefore, clinicians must be crucial in determining the appropriate clinical and radiographic manifestations. Treating these cases is also challenging. Consequently, clinicians should be aware of these complications to enhance the pro...