Low-dose methotrexate in sickle-cell disease: a pilot study with rationale borrowed from rheumatoid arthritis

Brandalise, Sílvia Regina; Assis, Rosemary; Laranjeira, Angelo Brunelli Albertoni; Yunes, José Andrés; Campos-Lima, Pedro O. de

doi:10.1186/s40164-017-0078-1

Cited by 12 publications

(8 citation statements)

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“…A small study of 14 adults on HU with severe and refractory SCD trialled the use of methotrexate by injection 10 mg weekly for 12 weeks. The study demonstrated an improvement in chronic pain and quality of life 38 . As mentioned previously, methotrexate's main drawback is cytopenia which must duly be gauged in patients who are already on HU.…”

Section: Therapy Of Autoimmune Disease In Sickle Cell Diseasesupporting

confidence: 52%

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Autoimmune disease and sickle cell anaemia: ‘Intersecting pathways and differential diagnosis’

et al. 2022

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Sickle cell disease (SCD) is an inherited disorder, which occurs due to a single gene mutation. It has multisystemic manifestations, affecting millions of people worldwide. The effect of SCD on joints and musculature can overlap with clinical features of autoimmune disease (AD). It is therefore difficult for clinical haematologists and physicians treating SCD patients to discriminate between these two conditions clinically. A delay in diagnosis leads to untreated symptoms and treatment differs considerably. An accurate knowledge of clinical findings and laboratory results of AD and SCD can help physicians avoid this. In the review that follows, we examine the existing literature on SCD and AD, and describe the features that may distinguish SCD and autoimmune disease such as systemic lupus erythematosus and rheumatoid arthritis. We aim to guide clinical haematologists and physicians towards a more rapid diagnosis of AD in sickle cell anaemia patients, by correct interpretation of the clinical assessment and commonly available diagnostics.

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Section: Therapy Of Autoimmune Disease In Sickle Cell Diseasesupporting

confidence: 52%

“…The study demonstrated an improvement in chronic pain and quality of life. 38 As mentioned previously, methotrexate's main drawback is cytopenia which must duly be gauged in patients who are already on HU. Its safe usage in patients of a childbearing age must also be considered.…”

Section: Th Er a Py Of Au Toi M Mu N E Dise Ase I N Sick L E Ce L L D...mentioning

confidence: 99%

Autoimmune disease and sickle cell anaemia: ‘Intersecting pathways and differential diagnosis’

et al. 2022

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“…The authors observed that the frequency of VOC did not decrease; however, avascular necrosis pain diminished, bringing gain in physical functioning, which suggested some benefit with the combination of MTX and hydroxyurea. Low platelet counts were observed as adverse effects with the double therapy [ 72 ]. Furthermore, patients with SCD will have compensatory reticulocytosis which can be impaired with MTX.…”

Section: Methodsmentioning

confidence: 99%

Rheumatoid Arthritis in Sickle-Cell Population: Pathophysiologic Insights, Clinical Evaluation and Management

et al. 2017

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The advent of hydroxyurea and advanced medical care, including immunizations has led to improved survival among patients with Sickle Cell Disease (SCD). This prolonged survival however, introduces a chronic inflammatory disorder, Rheumatoid Arthritis (RA), which presents at a relatively older age and is rarely reported among SCD patients. In this review, we highlight the epidemiological association of SCD-RA and discuss the underlying common pathogenetic mechanisms, such as endothelial dysfunction, the role of inflammatory cytokines and oxidative stress. We also point to the difficulties in ascertaining the clinical diagnosis of RA in SCD patients. Finally, we provide rationale for therapeutic options available for RA and the challenges in the management of these patients with agents that are known to increase the risk of infection and immunosuppression such as steroids, disease modifying anti-rheumatic drugs and biologics.

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“…An improvement in the anemia was observed. According to Brandalize, the use of methotrexate resulted in an improvement in pain and joint functionality; however, a disturbance in the platelet count was observed [14].…”

Section: Case Presentationmentioning

confidence: 99%

Rheumatoid arthritis in a sickle cell patient: a dangerous association?

Diakité¹,

Traoré

Touré

et al. 2021

jimsa

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Introduction - The diagnosis of rheumatoid arthritis remains a challenge because sickle cell disease can result in various rheumatological manifestations, including joint and bone pain. The concomitant presence of rheumatoid arthritis and sickle cell disease makes the therapeutic management of both conditions problematic. Observation - A 24-year-old man, a nurse by profession, has been followed for 10 years for homozygous sickle cell disease at the Sickle Cell Disease Research Center (CRLD) of Bamako, Mali. He has presented for 8 months symmetrical polyarthritis with morning stiffness of 3 hours, distinct from the usual vaso-occlusive crisis. The Analog Visual Scale was estimated at 80/100. He reported unquantified weight loss and asthenia. The physical examination showed a deformity in bilateral ulnar deviation, flexion of the right elbow, twelve painful joints, and five swollen joints. Normochromic normocytic anemia (hemoglobin 8.3g/dl), inflammatory syndrome with C - Reactive Protein (CRP) 130.91 mg, and Sedimentation Rate (ESR) 72mm at the first hour were noted. Rheumatoid Factor was weakly positive at 21.3 IU and Anti Citrullinated Peptide Antibodies at 385.2 IU. The radiography discovered bilateral erosive carpets without associated tarsitis and osteonecrosis of both femoral heads. The diagnosis of a very active immunopositive erosive rheumatoid arthritis meeting the criteria of ACR / EULAR 2010 was retained. A treatment based on prednisone 10 mg per day was initiated, associated with methotrexate at a dosage of 15 mg weekly in single-dose, folic acid, calcium, and vitamin D. Conclusion - The coexistence of rheumatoid arthritis in sickle cell patients makes the diagnosis of polyarthritis difficult.

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Low-dose methotrexate in sickle-cell disease: a pilot study with rationale borrowed from rheumatoid arthritis

Cited by 12 publications

References 59 publications

Autoimmune disease and sickle cell anaemia: ‘Intersecting pathways and differential diagnosis’

Autoimmune disease and sickle cell anaemia: ‘Intersecting pathways and differential diagnosis’

Rheumatoid Arthritis in Sickle-Cell Population: Pathophysiologic Insights, Clinical Evaluation and Management

Rheumatoid arthritis in a sickle cell patient: a dangerous association?

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