Rheumatoid Arthritis in a Patient with Beta-Thalassemia/Hemoglobin E Disease: 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 not corrected, the specific etiologies should be tried to clarify as in our patient. She is a 59-year old Thai patient who was definitely diagnosed as having 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, and the morning stiffness of fingers. The physical examination confirms the arthritidis of MCP joints of both indices, both middle fingers, right thumb, both wrists and both knees and the blood tests reveal 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 g% to 9.0 g% whereas the MCV and MCH are still low. The serum ferritin is not low and hemoglobin electrophoresis reveals Hb AEF. Then she is diagnosed as beta thalassemia / Hb E disease. Because the patients with beta thalassemia/Hb E may have various immune alterations whereas rheumatoid arthritis has an autoimmune process as a basic pathogenesis, both diseases may be related however, the definite association cannot be elucidated so far.