Skip to main content

Rheumatoid arthritis in patients with hemoglobinopathies

Rheumatology International volume 32, pages 2889–2892 (2012)Cite this article

Abstract

Rheumatoid arthritis (RA) in patients suffering from hemoglobinopathies is an important clinical problem, but the correlation between these diseases is still imperfectly known. The aim of this study was to analyze the clinical, serological and radiological characteristics of RA occurring in patients with hemoglobinopathies (thalassemia major, thalassemia intermedia and sickle-cell disease). In a single institution, in an adult cohort of 90 patients with hemoglobinopathies, we investigated retrospectively medical records of the patients. We evaluated the clinical findings, the autoantibodies and the radiological progression of patients who were diagnosed with RA according the American College of Rheumatology (ACR) criteria for RA. There were found 4 patients, with thalassemia major, who fulfilling the ACR criteria for RA. The clinical picture of the patients revealed a mild form of arthritis of the knees, shoulders, wrist and hands, while one patient had episcleritis. All patients had radiological damage compatible with RA (Larsen’s score, 28.75 ± 29). All had positive rheumatoid factor, while anti-cyclic citrullinated peptide antibodies were positive in 1 patient. Three patients received steroid treatment and one immunosuppressive agent (methotrexate). True RA with low frequency of extra-articular manifestations is described. The diagnosis of RA must be suspected in patients with hemoglobinopathies picture and chronic arthritis of small joints.

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

43,34 €

Price includes VAT (Finland)
Tax calculation will be finalised during checkout.

References

  1. Giakoumi X, Tsironi M, Floudas C, Polymeropoylos E, Papalambros E, Aessopos A (2005) Rheumatoid arthritis in thalassemia intermedia: coincidence or association? Isr Med Assoc J 7:667–669

    PubMed  Google Scholar 

  2. Steinberg MH (1999) Management of sickle cell disease. N Engl J Med 340:1021–1030

    PubMed  Article  CAS  Google Scholar 

  3. Almeida A, Roberts I (2005) Bone involvement in sickle cell disease. Br J Haematol 129:482–490

    PubMed  Article  Google Scholar 

  4. Schumacher HR, Dorwart BB, Bond J, Alavi A, Miller W (1977) Chronic synovitis with early cartilage destruction in sickle cell disease. Ann Rheum Dis 36:413–419

    PubMed  Article  CAS  Google Scholar 

  5. Crout JE, McKenna CH, Petitt RM (1976) Symptomatic joint effusions in sickle cell-beta-thalassemia disease. Report of a case. JAMA 235:1878–1879

    PubMed  Article  CAS  Google Scholar 

  6. Gratwick G, Peterson C, Bohne WHO (1977) The arthropathy of β-thalassemia. XIV International Congress of Rheumatology, San Francisco

    Google Scholar 

  7. Gratwick GM, Bullough PG, Bohne WH, Markenson AL, Peterson CM (1978) Thalassemic osteoarthropathy. Ann Intern Med 88:494–501

    PubMed  CAS  Google Scholar 

  8. Marcolongo R, Trotta F, Scaramelli M (1975) Letter: Beta-thalassaemic trait and rheumatoid arthritis. Lancet 1(7916):1141

    PubMed  Article  CAS  Google Scholar 

  9. Górriz L, De León C, Herrero-Beaumont G, del Vallado PF (1983) Arthritis in beta-thalassemia minor. Arthritis Rheum 26:1292–1293

    PubMed  Article  Google Scholar 

  10. Arman MI, Butun B, Doseyen A, Bircan I, Guven A (1992) Frequency and features of rheumatic findings in thalassaemia minor: a blind controlled study. Br J Rheumatol 31:197–199

    PubMed  Article  CAS  Google Scholar 

  11. Montecucco C, Caporali R, Rossi S, Epis O (1999) Rheumatoid arthritis in beta-thalassaemia trait. Rheumatology (Oxford) 38:1021–1022

    Article  CAS  Google Scholar 

  12. Drosos AA, Lanchbury JS, Panayi GS, Moutsopoulos HM (1992) Rheumatoid arthritis in Greek and British patients. A comparative clinical, radiologic, and serologic study. Arthritis Rheum 35:745–748

    PubMed  Article  CAS  Google Scholar 

  13. Ronda E, Ruiz MT, Pascual E, Gibson T (1994) Differences between Spanish and British patients in the severity of rheumatoid arthritis: comment on the article by Drosos et al. Arthritis Rheum 37:147–148

    PubMed  Article  CAS  Google Scholar 

  14. Cimmino MA, Salvarani C, Macchioni P et al (2000) Extra-articular manifestations in 587 Italian patients with rheumatoid arthritis. Rheumatol Int 19:213–217

    PubMed  Article  CAS  Google Scholar 

  15. Nistala K, Murray KJ (2001) Co-existent sickle cell disease and juvenile rheumatoid arthritis. Two cases with delayed diagnosis and severe destructive arthropathy. J Rheumatol 28:2125–2128

    PubMed  CAS  Google Scholar 

  16. Marino C, McDonald E (1990) Rheumatoid arthritis in a patient with sickle cell disease. J Rheumatol 17:970–972

    PubMed  CAS  Google Scholar 

  17. Drosos AA, Alamanos I, Voulgari PV et al (1997) Epidemiology of adult rheumatoid arthritis in northwest Greece 1987–1995. J Rheumatol 24:2129–2133

    PubMed  CAS  Google Scholar 

  18. Ezer U, Gülderen F, Culha VK, Akgül N, Gürbüz O (2002) Immunological status of thalassemia syndrome. Pediatr Hematol Oncol 19:51–58

    PubMed  Article  Google Scholar 

  19. Bowlus CL (2003) The role of iron in T cell development and autoimmunity. Autoimmun Rev 2:73–78

    PubMed  Article  CAS  Google Scholar 

  20. Hoppe C, Klitz W, D’Harlingue K et al (2007) Confirmation of an association between the TNF(-308) promoter polymorphism and stroke risk in children with sickle cell anemia. Stroke 38:2241–2246

    PubMed  Article  CAS  Google Scholar 

  21. Koethe SM, Casper JT, Rodey GE (1976) Alternative complement pathway activity in sera from patients with sickle cell disease. Clin Exp Immunol 23:56–60

    PubMed  CAS  Google Scholar 

  22. Pathare A, Al Kindi S, Alnaqdy AA, Daar S, Knox-Macaulay H, Dennison D (2004) Cytokine profile of sickle cell disease in Oman. Am J Hematol 77:323–328

    PubMed  Article  CAS  Google Scholar 

  23. Castellino G, Govoni M, Trotta F (2000) Rheumatoid arthritis in beta-thalassaemia trait. Rheumatology (Oxford) 39:1286–1287

    Article  CAS  Google Scholar 

  24. Berkovitch M, Laxer RM, Inman R et al (1994) Arthropathy in thalassaemia patients receiving deferiprone. Lancet 343(8911):1471–1472

    PubMed  Article  CAS  Google Scholar 

Download references

Conflict of interest

The authors declare that they have no conflict of interest.

Author information

Affiliations

  1. Haematology Clinic, Department of Internal Medicine, Medical Scholl, University of Ioannina, 45110, Ioannina, Greece

    Xanthi I. Pliakou, Frideriki P. Koutsouka, Konstantinos L. Bourantas & Evangelos C. Briasoulis

  2. Department of Social Medicine and Mental Health, Postgraduate Course of “Pain Management”, Medical Scholl, University of Ioannina, 45110, Ioannina, Greece

    Xanthi I. Pliakou & Dimitrios Damigos

  3. Rheumatology Clinic, Department of Internal Medicine, Medical Scholl, University of Ioannina, 45110, Ioannina, Greece

    Paraskevi V. Voulgari

Authors
  1. Xanthi I. Pliakou
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Frideriki P. Koutsouka
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Dimitrios Damigos
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Konstantinos L. Bourantas
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Evangelos C. Briasoulis
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Paraskevi V. Voulgari
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Paraskevi V. Voulgari.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Pliakou, X.I., Koutsouka, F.P., Damigos, D. et al. Rheumatoid arthritis in patients with hemoglobinopathies. Rheumatol Int 32, 2889–2892 (2012). https://doi.org/10.1007/s00296-011-2125-2

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00296-011-2125-2

Keywords

  • Hemoglobinopathies
  • Rheumatoid arthritis
  • Thalassemia intermedia
  • Thalassemia major
  • Sickle-cell disease
  • Chelation