Rheumatoid Arthritis in a Sickle Cell Patient: a Dangerous Association?
Introduction - The diagnosis of rheumatoid arthritis remains a challenge because sickle cell disease can result in various rheumatological manifestations, including joint and bone pain. The concomitant presence of rheumatoid arthritis and sickle cell disease makes the therapeutic management of both conditions problematic.
Observation - A 24-year-old man, a nurse by profession, has been followed for 10 years for homozygous sickle cell disease at the Sickle Cell Disease Research Center (CRLD) of Bamako, Mali. He has presented for 8 months symmetrical polyarthritis with morning stiffness of 3 hours, distinct from the usual vaso-occlusive crisis. The Analog Visual Scale was estimated at 80/100. He reported unquantified weight loss and asthenia. The physical examination showed a deformity in bilateral ulnar deviation, flexion of the right elbow, twelve painful joints, and five swollen joints. Normochromic normocytic anemia (hemoglobin 8.3g/dl), inflammatory syndrome with C - Reactive Protein (CRP) 130.91 mg, and Sedimentation Rate (ESR) 72mm at the first hour were noted. Rheumatoid Factor was weakly positive at 21.3 IU and Anti Citrullinated Peptide Antibodies at 385.2 IU. The radiography discovered bilateral erosive carpets without associated tarsitis and osteonecrosis of both femoral heads. The diagnosis of a very active immunopositive erosive rheumatoid arthritis meeting the criteria of ACR / EULAR 2010 was retained. A treatment based on prednisone 10 mg per day was initiated, associated with methotrexate at a dosage of 15 mg weekly in single-dose, folic acid, calcium, and vitamin D.
Conclusion - The coexistence of rheumatoid arthritis in sickle cell patients makes the diagnosis of polyarthritis difficult.
2. Xanthi I P, Frideriki P K, Dimitrios D, and al. Rheumatoid arthritis in patients with hemoglobinopathies. Rheumatol Int 2012 ; 32 : 2889–2892.
3. Zomalhèto Z, Baglo T, Gounongbé M, and al. Association polyarthrite rhumatoide et drépanocytose au sein de la population béninoise: difficultés diagnostiques et thérapeutiques. Le rhumatol 2018; 2: 28 -31.
4. Schumaker HR. Chronic synovitis with early cartilage destruction in sickle cell disease. Ann Rheum Dis. 1997; 36:413–419.
5. McFarlane I M, Ozeri D J, Pathiparampil J, and al. Prevalence and Clinical Characteristics of Rheumatoid Arthritis in an Inner City Population with Sickle Cell Disease. Rheumatol 2017 ; 7(2) :
6. Jean-Baptiste G, De Ceulaer K. Actualité des manifestations rhumatologiques des hémoglobinopathies. Rev rhum 2003 ; 70 : 157–161.
7. Habibi A, Bachir D, Godeau B. Complications aigues de la drépanocytose. Rev Prat 2004 ; 1548–56.
8. Lionnet F, Stankovic K, Girot R. Drépanocytose de l'adulte. EMC (Elsevier Masson SAS), Hématologie 2009 ; 13-006-D-16.
9. Combe B Polyarthrite rhumatoïde de l’adulte I. Aspects cliniques. Encyclopédie Médico-Chirurgicale Masson,Paris, 2007 ,14-220-A-10.
10. Lionnet F, Stankovic K, Girot R. Drépanocytose de l’adulte. EMC – Hématol 2009 ; 4 (2) : 1 19.
11. Habibi A, Arlet J-B, Stankovic K and al. Recommandations françaises de prise en charge de la drépanocytose de l’adulte : actualisation 2015. Rev Méd Intern 2015 ; 36 (1) : 5S3-5S84.
12. Ruyssen-Witrand A, Fautrel B, Saraux A and al. Infections induites par de faibles doses de corticoïdes dans la polyarthrite rhumatoïde : revue systématique de la littérature. Rev rhum 2010 ; 77 : 467–473.
13. Carli P, Landais C, Aletti M and al. Traitement actuel de la polyarthrite rhumatoïde. La Rev de méd interne 2009 ; 30 : 1067–1079.
14. Brandalise SR, Assis R, Laranjeira ABA, Yunes JA, de Campos Lima PO. Low-dose methotrexate in sickle-cell disease: a pilot study with rationale borrowed from rheumatoid arthritis. Exp Hematol Oncol. 2017 ; 6 : 18. [PubMed: 28638723].
Copyright (c) 2020 Journal of Internal Medicine: Science & Art
This work is licensed under a Creative Commons Attribution 4.0 International License.
Authors who publish with this journal agree to the following terms:
Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
Authors are permitted and encouraged to post links to their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work.