镰状细胞病的炎症性关节炎治疗是否不同？
Is the treatment of inflammatory arthritis different in sickle cell disease?
机构信息
Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Hatay Mustafa Kemal University, Hatay, Turkey.
Division of Hematology, Department of Internal Medicine, Faculty of Medicine, Hatay Mustafa Kemal University, Hatay, Turkey.
出版信息
Turk J Med Sci. 2022 Jun;52(5):1721-1728. doi: 10.55730/1300-0144.5515. Epub 2022 Oct 19.
BACKGROUND
Musculoskeletal findings are common in sickle cell patients and may be confused with inflammatory arthritis. In addition, complications such as frequent infections may create difficulties while choosing drugs such as steroids, methotrexate, or antiTNFs. Our aim is to reveal whether the treatment is different in sickle cell patients with rheumatic diseases such as rheumatoid arthritis.
METHODS
Patients followed by Rheumatology and Hematology divisions of Hatay Mustafa Kemal University Hospital were retrospectively screened. Excluding patients with musculoskeletal findings associated with sickle cell disease (SCD), patients with chronic or acute inflammatory arthritis were enrolled into study. Demographic data, disease activities, the drugs used, frequency of infection, and sickle cell-related crisis before and after rheumatic disease diagnosis-treatment of the patients were examined.
RESULTS
Inflammatory rheumatic disease was detected in 14 of 28 sickle cell patients evaluated in the rheumatology department for musculoskeletal complaints. Twelve of the patients were female and 2 were male. The median duration of rheumatic disease was 27 months (16.5). Eight of these patients had rheumatoid arthritis, 1 had ankylosing spondylitis, reactive arthritis, gout, connective tissue disease, undifferentiated monoarthritis, and 1 patient had undifferentiated oligoarthritis. For rheumatic disease, 11 (78.6%) of the patients were using steroids, 8 (57.1%) hydroxychloroquine, 4 (28.6%) methotrexate and sulfasalazine, 2 (14.3%) leflunomide, 1 (7.1%) anti-TNF (etanercept), and 1 allopurinol and colchicine. The frequency of SCD-related crisis and annual serious infections before and after rheumatic disease treatment were similar (p = 0.31).
DISCUSSION
The clinical manifestations of inflammatory arthritis such as rheumatoid arthritis and sickle cell disease may overlap. The use of drugs such as steroids, methotrexate, or anti-TNF in sickle cell patients with rheumatic disease is the same as in patients without sickle cell disease. However, treatment should be individualized in patients with complications such as infection.
背景
肌肉骨骼表现常见于镰状细胞病患者，可能与炎症性关节炎混淆。此外，频繁感染等并发症可能会在选择类固醇、甲氨蝶呤或抗 TNF 等药物时造成困难。我们的目的是揭示镰状细胞病患者的治疗方法是否与类风湿关节炎等风湿性疾病不同。
方法
回顾性筛选在哈塔伊穆斯塔法·凯末尔大学医院风湿科和血液科就诊的患者。排除镰状细胞疾病相关肌肉骨骼表现的患者，将患有慢性或急性炎症性关节炎的患者纳入研究。检查患者的人口统计学数据、疾病活动度、使用的药物、感染频率以及风湿性疾病诊断和治疗前后的镰状细胞相关危象。
结果
在因肌肉骨骼问题在风湿科就诊的 28 例镰状细胞患者中，发现 14 例患有炎症性风湿性疾病。其中 12 例为女性，2 例为男性。风湿性疾病的中位病程为 27 个月（16.5）。这些患者中有 8 例患有类风湿关节炎，1 例患有强直性脊柱炎、反应性关节炎、痛风、结缔组织病、未分化单关节炎和 1 例未分化少关节炎。对于风湿性疾病，11 例（78.6%）患者使用类固醇，8 例（57.1%）使用羟氯喹，4 例（28.6%）使用甲氨蝶呤和柳氮磺胺吡啶，2 例（14.3%）使用来氟米特，1 例（7.1%）使用抗 TNF（依那西普），1 例使用别嘌醇和秋水仙碱。风湿性疾病治疗前后镰状细胞病相关危象和年度严重感染的频率相似（p = 0.31）。
讨论
类风湿关节炎等炎症性关节炎的临床表现可能与镰状细胞病重叠。在患有风湿性疾病的镰状细胞病患者中使用类固醇、甲氨蝶呤或抗 TNF 等药物与无镰状细胞病患者相同。然而，对于感染等并发症的患者，治疗应个体化。
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