Haematology Clinic, Department of Internal Medicine, Medical Scholl, University of Ioannina, 45110 Ioannina, Greece.
Rheumatol Int. 2012 Sep;32(9):2889-92. doi: 10.1007/s00296-011-2125-2. Epub 2011 Sep 7.
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.
类风湿关节炎（RA）在患有血红蛋白病的患者中是一个重要的临床问题，但这些疾病之间的相关性仍不完全清楚。本研究的目的是分析发生在血红蛋白病（重型地中海贫血、中间型地中海贫血和镰状细胞病）患者中的 RA 的临床、血清学和放射学特征。在一家机构中，我们对 90 名血红蛋白病成年患者的病历进行了回顾性研究。我们根据美国风湿病学会（ACR）的 RA 标准评估了符合 RA 诊断的患者的临床发现、自身抗体和放射学进展。发现有 4 名重型地中海贫血患者符合 ACR 的 RA 标准。患者的临床表现为膝关节、肩部、腕关节和手部的轻度关节炎，其中 1 例患者有巩膜炎。所有患者均有符合 RA 的放射学损害（Larsen 评分 28.75±29）。所有患者的类风湿因子均为阳性，1 例患者的抗环瓜氨酸肽抗体阳性。3 名患者接受了类固醇治疗，1 名患者接受了免疫抑制剂（甲氨蝶呤）治疗。描述了一种具有低频率关节外表现的真正 RA。在有小关节慢性关节炎的血红蛋白病患者中应怀疑 RA 的诊断。
