Rheumatoid Arthritis ina Beta-Thalassemia/Hemoglobin E Patient: A Case Report

Abstract

          Anemia of chronic inflammation is commonly found in most cases of rheumatoid arthritis but the degree of anemia is usually mild. It always recovers after rheumatoid arthritis is adequately treated until in remission. If the anemia is still continued, the etiologies should be tried to clarify as in our patient.She is a 59-year old Thai patient who was definitely diagnosed as rheumatoid arthritis for a year, based on the combination of chronic pain of both of wrists, ankles and many inter-phalangeal joints for a year, morning stiffnessof fingers, inflammation of the right 3^rd and 5^th MCP joints, positive rheumatoid factor and the rising of ESR and CRP. She has been treated with chloroquine and diclofenac until the patient is in clinical remission. The hemoglobin concentration is raised from 7.2 to 9.0 g% whereas the MCV and MCH are still low. The hepatosplenomegalyis not found on the physical examination. The serum ferritin is not low and the hemoglobin electrophoresisreveals Hb AEF. She has never been transfused, so she is additionally diagnosed as beta thalassemia/Hb E disease. Because the patients with beta thalassemia/ Hb Emay have various immune alterations whereas rheumatoid arthritis has an autoimmune process as a basic pathogenesis, both diseases may be directly related however, the definite association cannot be elucidated so far.