Journal of Medical Cases, ISSN 1923-4155 print, 1923-4163 online, Open Access
Article copyright, the authors; Journal compilation copyright, J Med Cases and Elmer Press Inc
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Case Report

Volume 7, Number 8, August 2016, pages 334-340


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

Figures

Figure 1.
Figure 1. X-ray of right knee showing (A) erosive arthritis in the joint due to RA and (B) sclerosis in the tibial metaphysis due to SCD.
Figure 2.
Figure 2. X-ray of left knee lateral view showing (A) erosive arthritis in the joint due to RA and (B) sclerosis in the diaphysis due to SCD.
Figure 3.
Figure 3. X-ray of left elbow showing (A) erosive RA.
Figure 4.
Figure 4. X-ray of right shoulder showing (A) avascular necrosis of humeral head with preserved articular surface.
Figure 5.
Figure 5. Right hand X-ray shows (A) erosive arthritis, subluxation at the metacarpophalangeal joints and periarticular osteopenia.
Figure 6.
Figure 6. Comparison of biomarkers LDH and CRP in case 1 during admissions. Hospitalization for painful events due to sickle cell disease (red arrow). Hospitalization for painful events due to rheumatoid arthritis (green arrow).
Figure 7.
Figure 7. Reticulocyte count and total bilirubin levels in case 1 during admissions in a 5-year period.

Tables

Table 1. Baseline Characteristics of Patients at the Time of Diagnosis With RA
 
Case 1Case 2Case 3Case 4Case 5Case 6Case 7Case 8
Hgb: hemoglobin; HPLC: high performance liquid chromatography; Hgb S: sickle cell hemoglobin; Hgb F: fetal hemoglobin; Hgb A&A2: adult hemoglobins; ESR: erythrocyte sedimentation rate; CRP: C-reactive protein; RF: rheumatoid factor antibody; CCP IgG: cyclic citrullinated peptide antibody.
Age at diagnosis of RA3336225537385329
GenderMaleFemaleFemaleFemaleFemaleFemaleFemaleFemale
Date of diagnosis of RAMay 2010May 2008March 2012April 2010August 2003December 2015July 2010August 1999
Sickle cell genotypeSSSSSSSSSSSSSSSS
Hgb (mg/dL)7.65.36.76.9887.17.3
HPLC
  Hgb S%8984.490.48590.778.387.586.4
  Hgb F%39.72.26.73.312.52.27.5
  Hgb A%200006.600
  Hgb A2%4.63.84.74.34.32.64.94.6
Inflammatory markers
  ESR (mm/h)9688140541159745118
  CRP (mg/L)77.947.612.39161.032.781.13.4
Immunologic markers
  RF (IU/mL)37826318861018881161124
  CCP IgG (mg/L)> 250> 250> 250> 250> 250> 250> 250142

 

Table 2. Number of Admissions for Painful Events Before and After Diagnosis of RA
 
Case 1Case 2Case 3Case 4Case 5Case 6Case 7Case 8
Data only represent the available information from our institution.
Painful events requiring admission in the 5 years period before diagnosis of RA21000910
Painful events requiring admission in the 5 years period after diagnosis of RA53162162146