Session Information
Date: Monday, November 14, 2016
Title: Rheumatoid Arthritis – Clinical Aspects - Poster II: Co-morbidities and Complications
Session Type: ACR Poster Session B
Session Time: 9:00AM-11:00AM
Background/Purpose: Rheumatoid arthritis (RA) has been rarely reported in association with sickle cell disease (SCD). It was hypothesized that sickle cell-associated vasculopathy impairs angiogenesis; a key step in the formation and maintenance of the panus in RA, thus preventing the development of RA. However, there is no substantial data available on the prevalence and clinical characteristics of RA in SCD patients. We performed a cross-sectional analysis to estimate the prevalence of RA in SCD population and to describe the clinical characteristics of RA associated with SCD.
Methods: Retrospective chart review of SCD and RA patients followed at 2 large urban hospitals. Seven RA/SCD patients were identified and compared to age and sex matched cohort of SCD only and of RA only group. All patients were black.
Results: Of the 658 SCD cases, 7 (1.0%) met ACR criteria for RA (SCD-RA), 411cases were RA only group. Mean age = (41.1±2.21 (±SEM) vs 34.55± 0.13), vs.60.7±16.3 P<0.01. Compared to age and sex matched groups of RA and of SCD, RA/SCD group tended to have more frequent hospitalization and increased LOS, as well as lower hemoglobin / hematocrit values. Other clinical and biochemical characteristics were similar for the 3 groups (table1). There were also no significant differences in rheumatologic parameters between SCD/RA and RA only groups, except for increase in periarticular osteopenia and difficulty in ADL among SCD/RA cohort (table2). Table 1 Comparison of the Clinical and Biochemical Characteristics of SCD, SCD and RA, and RA patients.
| Measurements | SCD (n=7) | SCD+RA (n=7) | RA (n=7) | P- Value |
| Age | 41.7 ± 3.9 | 41.7 ± 3.9 | 39.8 ± 4.1 | 0.93 |
| Body Mass Index | 23.5 ± 0.86 | 20.8 ± 1.9 | 25.6 ± 2.1 | 0.17 |
| Systolic BP | 119 ± 4.7 | 118 ± 5.0 | 128 ± 4.9 | 0.3 |
| Diastolic BP | 70 ± 1.8 | 68 ± 4.3 | 79 ± 5.8 | 0.19 |
| Hemoglobin | 8.3 ± 0.6 | 7.4 ± 0.49 | 11.0 ± 0.59 | <0.01 |
| Hematocrit | 25.7 ± 1.7 | 23.1 ± 1.5 | 34.6 ± 1.5 | <0.01 |
| CRP | 38.6 ± 23.3 | 12.2 ± 5.6 | 38.1 ± 13.8 | 0.47 |
| ESR | 63.0 ± 15.4 | 71.6 ± 20.2 | 37.0 ± 10.0 | 0.23 |
| Lymphocyte Count | 3.0 ± 1.9 | 3.9 ± 2.2 | 1.7 ± 1.0 | 0.023 |
| Creatinine | 0.57 ± 0.057 | 0.72 ± 0.097 | 0.8 ± 0.087 | 0.09 |
| Reticulocyte Count | 9.5 ± 2.4 | 13.2 ± 2.3 | —– | 0.28 |
| # of Hospitalizations | 8.7 ± 3.2 | 9.1 ± 4.9 | 1.8 ± 0.14 | 0.26 |
| Total length of stay in hospital | 52.1 ± 24.6 | 88.2 ± 40.7 | 6.4 ± 2.2 | 0.13 |
| # ED visits | 30.7 ± 22.0 | 12.8 ± 5.4 | 4.5 ± 0.86 | 0.37 |
| # Blood transfusions | 6.2 ± 3.8 | 6.5 ± 3.7 | 0.71 ± 0.47 | 0.34 |
| Acute Chest Syndrome | 71.4% (5/7) | 71.4% (5/7) | —– | 1.0 |
Table 2 Comparison of Clinical Characteristics and Radiographic Profiles in patients with SCD and RA, and RA alone.
| Measurements | SCD + RA (n=7) | RA (n=7) | P- Value |
| Rheumatoid Factor | 86% (6/7) | 71% (5/7) | 0.46 |
| Anti-citrullinated protein antibody | 83% (5/6) | 60% (3/5) | 0.54 |
| Antinuclear antibody | 40% (2/5) | 50% (3/6) | 1.0 |
| Prednisone | 71.4% (5/7) | 71.4% (5/7) | 1.0 |
| Methotrexate | 42.9% (3/7) | 71.4% (5/7) | 0.59 |
| Hydroxychloroquine | 14.3% (1/7) | 14.3% (1/7) | 0.26 |
| Biologics | 14.3% (1/7) | 14.3% (1/7) | 1.0 |
| Leflunomide | 42.9% (3/7) | 42.9% (3/7) | 1.0 |
| Duration of Morning Stiffness | 127.5±18.8 | 55.3±34.7 | 0.10 |
| Peri-articular Osteopenia | 100% (5/5) | 0% (0/5) | 0.01 |
| Erosive arthritis | 50% (3/6) | 17% (1/6) | 0.54 |
| Difficulty with ADLs | 57 % (4/7) | 0% (0/7) | 0.01 |
Conclusion: The prevalence of RA among SCD patients is similar to that of the general population and is associated with increased hospitalizations and length of stay as well as difficulty in activities of daily living. This is contrary to previous reports from 1980-1990s indicating rare occurrence of RA in SCD patients. Given the increase prevalence of RA with age, our findings are likely a reflection of increased longevity among SCD patients with hydroxyurea and other modern interventions.
To cite this abstract in AMA style:
Ozeri DJ, Pathiparampil J, Sanchez R, McFarlane IM. Prevalence and Clinical Characteristics of Rheumatoid Arthritis in Sickle Cell Patients: A Cross-Sectional Analysis [abstract]. Arthritis Rheumatol. 2016; 68 (suppl 10). https://acrabstracts.org/abstract/prevalence-and-clinical-characteristics-of-rheumatoid-arthritis-in-sickle-cell-patients-a-cross-sectional-analysis/. Accessed .« Back to 2016 ACR/ARHP Annual Meeting
ACR Meeting Abstracts - https://acrabstracts.org/abstract/prevalence-and-clinical-characteristics-of-rheumatoid-arthritis-in-sickle-cell-patients-a-cross-sectional-analysis/