Rheumatoid Arthritis and Sickle Cell Disease: A Study of 18 Cases

Abstract

Background: The coexistence of rheumatoid arthritis and sickle cell trait or disease has seldom been documented in reports from sub-Saharan Africa. This study aimed to characterise the epidemiological, diagnostic and prognostic features of this coexistence within a Senegalese rheumatology department. Patients and Methods: A retrospective case-control investigation was undertaken between March 2012 and June 2024 within the rheumatology department at Aristide Le Dantec University Hospital, Dakar (currently relocated to the COUD hospital). Patients with concurrent rheumatoid arthritis and sickle cell disease were compared with those who had rheumatoid arthritis alone. Results: Out of a total of 867 cases of rheumatoid arthritis, 18 cases were associated with sickle cell disease, representing a prevalence of 2.07%. The sickle cell group comprised 13 women and 5 men, with a mean age of 44.1 years. The genotype was AS in 14 cases, SS in 3 cases, and SC in 1 case. Rheumatoid arthritis activity was numerically greater in the combined-disease group (DAS28: 5.62 vs. 5.01 in controls; p = 0.14). The mean HAQ score was 1.6 and 1.4, respectively (p = 0.16). Two cases of aseptic necrosis of the femoral head and one case of diffuse interstitial lung disease were observed in patients with sickle cell disease, but not in controls. Mean haemoglobin was 9.9 g/dL in the control group and 8.6 g/dL among the sickle cell cases. Conclusion: Although our series is limited, it shows that this association primarily involves predominantly women, whose mean age was 44.1 years. Heterozygous sickle cell trait (AS) accounted for 77.8% of cases. The association showed numerically greater rheumatoid arthritis activity together with greater functional impairment.