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Sugandhi A, Dubey K, Panda S, Nafe Z. Navigating the Diagnosis and Management of Rheumatoid Arthritis in the Context of Sickle Cell Disease: A Dual Challenge. Cureus 2023; 15:e44615. [PMID: 37799227 PMCID: PMC10547604 DOI: 10.7759/cureus.44615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/03/2023] [Indexed: 10/07/2023] Open
Abstract
Sickle cell disease is a common condition in the eastern part of India and can often present with pain crisis, vasculo-occlusive crisis and anemia. These patients seldom have coexisting rheumatological illnesses like rheumatoid arthritis that are camouflaged with the pain crisis of sickle cell disease, leading to a delay in the diagnosis and a delay in initiating the treatment which leads to a poorer quality of life. Herein we discuss a case of sickle cell disease presenting concomitantly with the features of rheumatoid arthritis and the challenges faced in the diagnosis and treatment.
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Affiliation(s)
| | - Kreetee Dubey
- General Medicine, Tata Main Hospital, Jamshedpur, IND
| | - Suman Panda
- General Medicine, Tata Main Hospital, Jamshedpur, IND
| | - Zaid Nafe
- Gastroenterology, Tata Main Hospital, Jamshedpur, IND
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Piccin A, O'Connor-Byrne N, Daves M, Lynch K, Farshbaf AD, Martin-Loeches I. Autoimmune disease and sickle cell anaemia: 'Intersecting pathways and differential diagnosis'. Br J Haematol 2022; 197:518-528. [PMID: 35244209 DOI: 10.1111/bjh.18109] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Revised: 02/13/2022] [Accepted: 02/14/2022] [Indexed: 12/12/2022]
Abstract
Sickle cell disease (SCD) is an inherited disorder, which occurs due to a single gene mutation. It has multisystemic manifestations, affecting millions of people worldwide. The effect of SCD on joints and musculature can overlap with clinical features of autoimmune disease (AD). It is therefore difficult for clinical haematologists and physicians treating SCD patients to discriminate between these two conditions clinically. A delay in diagnosis leads to untreated symptoms and treatment differs considerably. An accurate knowledge of clinical findings and laboratory results of AD and SCD can help physicians avoid this. In the review that follows, we examine the existing literature on SCD and AD, and describe the features that may distinguish SCD and autoimmune disease such as systemic lupus erythematosus and rheumatoid arthritis. We aim to guide clinical haematologists and physicians towards a more rapid diagnosis of AD in sickle cell anaemia patients, by correct interpretation of the clinical assessment and commonly available diagnostics.
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Affiliation(s)
- Andrea Piccin
- Northern Ireland Blood Transfusion Service, Belfast, UK.,Department of Internal Medicine V, Medical University of Innsbruck, Innsbruck, Austria.,Department of Industrial Engineering, University of Trento, Trento, Italy
| | | | - Massimo Daves
- Clinical Biochemistry Laboratory, Bolzano General Hospital, Bolzano, Italy
| | - Kelvin Lynch
- Department of Haematology, Cork University Hospital, Cork, Ireland
| | | | - Ignacio Martin-Loeches
- Trinity College Dublin, School of Medicine, Dublin, Ireland.,Intensive Care Medicine, St James's Hospital, Dublin, Ireland
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Starosta RT, Hou YCC, Leestma K, Singh P, Viehl L, Manwaring L, Granadillo JL, Schroeder MC, Colombo JN, Whitehead H, Dickson PI, Hulbert ML, Nguyen HT. Infantile-onset Pompe disease complicated by sickle cell anemia: Case report and management considerations. Front Pediatr 2022; 10:944178. [PMID: 36245745 PMCID: PMC9555291 DOI: 10.3389/fped.2022.944178] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Accepted: 08/01/2022] [Indexed: 11/13/2022] Open
Abstract
Infantile-onset Pompe disease (IOPD) is a rare, severe disorder of lysosomal storage of glycogen that leads to progressive cardiac and skeletal myopathy. IOPD is a fatal disease in childhood unless treated with enzyme replacement therapy (ERT) from an early age. Sickle cell anemia (SCA) is a relatively common hemoglobinopathy caused by a specific variant in the hemoglobin beta-chain. Here we report a case of a male newborn of African ancestry diagnosed and treated for IOPD and SCA. Molecular testing confirmed two GAA variants, NM_000152.5: c.842G>C, p.(Arg281Pro) and NM_000152.5: c.2560C>T, p.(Arg854*) in trans, and homozygosity for the HBB variant causative of SCA, consistent with his diagnosis. An acute neonatal presentation of hypotonia and cardiomyopathy required ERT with alglucosidase alfa infusions preceded by immune tolerance induction (ITI), as well as chronic red blood cell transfusions and penicillin V potassium prophylaxis for treatment of IOPD and SCA. Clinical course was further complicated by multiple respiratory infections. We review the current guidelines and interventions taken to optimize his care and the pitfalls of those guidelines when treating patients with concomitant conditions. To the best of our knowledge, no other case reports of the concomitance of these two disorders was found. This report emphasizes the importance of newborn screening, early intervention, and treatment considerations for this complex patient presentation of IOPD and SCA.
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Affiliation(s)
- Rodrigo Tzovenos Starosta
- Division of Clinical Genetics and Genomics, Department of Pediatrics, Washington University School of Medicine, St. Louis, MO, United States
| | - Ying-Chen Claire Hou
- Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, MO, United States
| | - Katelyn Leestma
- Division of Clinical Genetics and Genomics, Department of Pediatrics, Washington University School of Medicine, St. Louis, MO, United States
| | - Prapti Singh
- Division of Clinical Genetics and Genomics, Department of Pediatrics, Washington University School of Medicine, St. Louis, MO, United States
| | - Luke Viehl
- Division of Newborn Medicine, Department of Pediatrics, Washington University School of Medicine, St. Louis, MO, United States
| | - Linda Manwaring
- Division of Clinical Genetics and Genomics, Department of Pediatrics, Washington University School of Medicine, St. Louis, MO, United States
| | - Jorge Luis Granadillo
- Division of Clinical Genetics and Genomics, Department of Pediatrics, Washington University School of Medicine, St. Louis, MO, United States
| | - Molly C Schroeder
- Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, MO, United States
| | - Jamie N Colombo
- Division of Pediatric Cardiology, Department of Pediatrics, Washington University School of Medicine, St. Louis, MO, United States
| | - Halana Whitehead
- Division of Newborn Medicine, Department of Pediatrics, Washington University School of Medicine, St. Louis, MO, United States
| | - Patricia Irene Dickson
- Division of Clinical Genetics and Genomics, Department of Pediatrics, Washington University School of Medicine, St. Louis, MO, United States
| | - Monica L Hulbert
- Division of Pediatric Hematology and Oncology, Department of Pediatrics, Washington University School of Medicine, St. Louis, MO, United States
| | - Hoanh Thi Nguyen
- Division of Clinical Genetics and Genomics, Department of Pediatrics, Washington University School of Medicine, St. Louis, MO, United States
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American Society of Hematology 2020 guidelines for sickle cell disease: management of acute and chronic pain. Blood Adv 2021; 4:2656-2701. [PMID: 32559294 DOI: 10.1182/bloodadvances.2020001851] [Citation(s) in RCA: 176] [Impact Index Per Article: 58.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Accepted: 05/09/2020] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND The management of acute and chronic pain for individuals living with sickle cell disease (SCD) is a clinical challenge. This reflects the paucity of clinical SCD pain research and limited understanding of the complex biological differences between acute and chronic pain. These issues collectively create barriers to effective, targeted interventions. Optimal pain management requires interdisciplinary care. OBJECTIVE These evidence-based guidelines developed by the American Society of Hematology (ASH) are intended to support patients, clinicians, and other health care professionals in pain management decisions for children and adults with SCD. METHODS ASH formed a multidisciplinary panel, including 2 patient representatives, that was thoroughly vetted to minimize bias from conflicts of interest. The Mayo Evidence-Based Practice Research Program supported the guideline development process, including updating or performing systematic reviews. Clinical questions and outcomes were prioritized according to importance for clinicians and patients. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach was used, including GRADE evidence-to-decision frameworks, to assess evidence and make recommendations, which were subject to public comment. RESULTS The panel reached consensus on 18 recommendations specific to acute and chronic pain. The recommendations reflect a broad pain management approach, encompassing pharmacological and nonpharmacological interventions and analgesic delivery. CONCLUSIONS Because of low-certainty evidence and closely balanced benefits and harms, most recommendations are conditional. Patient preferences should drive clinical decisions. Policymaking, including that by payers, will require substantial debate and input from stakeholders. Randomized controlled trials and comparative-effectiveness studies are needed for chronic opioid therapy, nonopioid therapies, and nonpharmacological interventions.
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Roizenblatt S, Cabañas-Pedro AC, Figueiredo MS. Rheumatoid arthritis and sickle cell disease: A potential association. Br J Haematol 2020; 191:e25-e28. [PMID: 32691416 DOI: 10.1111/bjh.16952] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
- Suely Roizenblatt
- Universidade Federal de Sao Paulo Escola Paulista de Medicina, Sao Paulo, Brazil
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Hughes M. Rheumatic Manifestations of Haemoglobinopathies. Curr Rheumatol Rep 2018; 20:61. [PMID: 30109514 DOI: 10.1007/s11926-018-0768-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
PURPOSE OF THE REVIEW To provide a clinically useful literature review on the rheumatic manifestations of haemoglobinopathies, critically analysing the literature from the past 5 years. RECENT FINDINGS There are limited new data to guide the management of rheumatic manifestations of haemoglobinopathies. Data further confirm the wide spectrum of potential rheumatic/MSK involvement in haemoglobinopathies, which poses both a diagnostic and therapeutic challenge. Inflammatory arthritis may be more common than previously believed. Steroid therapy by any route of administration can provocate a potential life-threatening vaso-occlusive crisis. Vitamin D deficiency is common. There are limited data to guide the drug treatment of reduced bone density in haemoglobinopathies. There have been a number of studies examining pain in sickle cell anaemia. Plasma levels of Klotho may represent a novel biomarker in patients with β-Thalassemia. There are little new data on the rheumatic manifestations in haemoglobinopathies and future high-quality research is needed.
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Affiliation(s)
- Michael Hughes
- Department of Rheumatology, Sheffield Teaching Hospitals NHS Foundation Trust, Royal Hallamshire Hospital, S10 2JF, Sheffield, UK.
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McFarlane IM, Ozeri DJ, Saperstein Y, Alvarez MR, Leon SZ, Koci K, Francis S, Singh S, Salifu M. Rheumatoid Arthritis in Sickle-Cell Population: Pathophysiologic Insights, Clinical Evaluation and Management. ACTA ACUST UNITED AC 2018; 7. [PMID: 29375934 PMCID: PMC5784436 DOI: 10.4172/2161-1149.1000225] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
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.
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Affiliation(s)
- Isabel M McFarlane
- Department of Medicine, Divisions of Rheumatology and Nephrology, State University of New York, USA
| | - David J Ozeri
- Department of Medicine, Division of Rheumatology, New York Presbyterian Methodist Hospital, USA
| | - Yair Saperstein
- Department of Medicine, Divisions of Rheumatology and Nephrology, State University of New York, USA
| | - Milena Rodriguez Alvarez
- Department of Medicine, Divisions of Rheumatology and Nephrology, State University of New York, USA
| | - Su Zhaz Leon
- Department of Medicine, Divisions of Rheumatology and Nephrology, State University of New York, USA
| | - Kristaq Koci
- Department of Medicine, Divisions of Rheumatology and Nephrology, State University of New York, USA
| | - Sophia Francis
- Department of Medicine, Divisions of Rheumatology and Nephrology, State University of New York, USA
| | - Soberjot Singh
- Department of Medicine, Divisions of Rheumatology and Nephrology, State University of New York, USA
| | - Moro Salifu
- Department of Medicine, Divisions of Rheumatology and Nephrology, State University of New York, USA
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