Differentiating Rheumatoid Arthritis Related Musculoskeletal Pain in Patients With Concurrent Sickle Cell Disease: A Case Series and Literature Review

Abstract

Rheumatoid arthritis (RA) can occur concurrently in patients with sickle cell disease (SCD). Both conditions can have similar musculoskeletal symptoms during painful exacerbations. SCD tends to be frequently labelled as the causative factor of painful events by both patients and providers alike. It is important to distinguish between these two conditions causing painful exacerbations to guide treatment plans. Our review of literature showed that the concurrent presentation of RA and SCD is not well described. We present a case series of eight patients with concurrent RA and SCD. We conducted a retrospective review of their charts to make observations about differences in musculoskeletal symptoms, biomarkers and radiological changes. Generally, RA affects smaller joints compared to SCD which affects larger joints. Radiological differences include bone infarcts and avascular necrosis in SCD versus erosive arthritis in RA. In terms of biomarkers, we are better guided using C-reactive protein (CRP) in conjunction with lactate dehydrogenase (LDH). Our case series demonstrates certain indicators which help make a clearer distinction between the two usually painful conditions.




J Med Cases. 2016;7(8):334-340
doi: http://dx.doi.org/10.14740/jmc2602e