Chronic osteo-articular changes in patients with sickle cell disease

Adv Rheumatol. 2021 Feb 19;61(1):11. doi: 10.1186/s42358-021-00169-5.

Abstract

Background: Sickle cell disease (SCD) is an autosomal recessive genetic disease in which a mutation occurs in the β-globin chain gene, resulting in abnormal hemoglobin levels. In an environment with reduced oxygen concentration, red blood cells change their conformation, resulting in chronic hemolysis and consequent anemia and vaso-occlusive crises with injuries to several organs, with a significant impairment of the osteoarticular system. This study aimed to verify the chronic osteoarticular alterations and their association with clinical and laboratory characteristics of patients with SCD with a more severe phenotype (SS and Sβ0), on a steady-state fasis.

Methods: Fifty-five patients were referred to a medical consultation with a specialized assessment of the locomotor system, followed by laboratory tests and radiographic examinations.

Results: In total, 74.5% patients had hemoglobinopathy SS; 67.3% were female; and 78.2% were non-whites. The mean patient age was 30.5 years. Most patients (61.8%) reported up to three crises per year, with a predominance of high-intensity pain (65.5%). Radiographic alterations were present in 80% patients. A total of 140 lesions were identified, most which were located in the spine, femur, and shoulders. Most lesions were osteonecrosis and osteoarthritis and were statistically associated with the non-use of hydroxyurea.

Conclusions: There was a high prevalence of chronic osteoarticular alterations, which was statistically associated only with the non-regular use of hydroxyurea.

Keywords: Hydroxyurea; Osteoarthritis; Osteonecrosis; Osteopenia; Sickle cell disease.

MeSH terms

  • Adolescent
  • Adult
  • Anemia, Sickle Cell / blood
  • Anemia, Sickle Cell / complications*
  • Anemia, Sickle Cell / drug therapy
  • Antisickling Agents / therapeutic use
  • Cross-Sectional Studies
  • Female
  • Hemoglobin, Sickle / genetics
  • Humans
  • Hydroxyurea / therapeutic use
  • Male
  • Osteoarthritis / diagnostic imaging*
  • Osteoarthritis / epidemiology
  • Osteonecrosis / diagnostic imaging*
  • Osteonecrosis / epidemiology
  • Skin Pigmentation
  • Young Adult

Substances

  • Antisickling Agents
  • Hemoglobin, Sickle
  • Hydroxyurea