Sickle Cell Arthropathy
Sickle cell arthropathy is a very serious disease and requires treatment, preferably with surgery. This condition affects the musculoskeletal system and is characterized by joint stiffness, pain, and inflammation. The disease is associated with numerous comorbidities and is often misdiagnosed. In addition, the symptoms can be triggered by a variety of different conditions. However, if left untreated, the disease can lead to severe complications. It is therefore imperative to get it diagnosed and treated as soon as possible.
In the perioperative period, sickle cell arthropathy presents with a number of complications. These complication rates are dependent on several factors such as the surgical procedure, patient condition before surgery, the team involved and the type of team.
Preoperative transfusion of red blood cells is frequently used in the management of sickle cell arthropathy. This is a safe and recommended practice. However, the risk of a transfusion-related complication may be higher in patients with sickle cell disease. The decision to use preoperative blood transfusion in sickle cell disease is not necessarily easy. It requires an understanding of the disease, the underlying pathophysiology, and the physiology of anaesthesia.
A review of the literature on perioperative care of sickle cell arthropathy revealed that the presence of a haematology consultation before surgery had a significant influence on postoperative complications. Specifically, the percentage of patients with sickle haemoglobin S before surgery was found to be a critical predictor of the occurrence of postoperative complications.
Anaesthesia is a crucial component of the perioperative care of sickle cell arthropathy. In addition, the presence of a haematology consultant before surgery can influence the practice of anaesthesiologists. Moreover, the number of sickle cell patients treated by anaesthesiologists per year can influence their practice.
As part of its multidisciplinary perioperative care, sickle cell arthropathy patients are usually hospitalized for a period of time before their elective surgical procedures. They are also hospitalized for a longer period in the case of emergency procedures. When these patients are hospitalized, they are required to have adequate hydration, oxygenation, and resuscitation.
Optimal multidisciplinary perioperative management includes anesthesiologists. Anaesthesiologists should understand the physiology of anaesthesia, the pathophysiology of sickle cell arthropathy, and current management goals.
While a majority of anaesthesiologists in Cameroon use preoperative blood transfusion to minimize the perioperative complications of sickle cell arthropathy, there are differences in their practices. Among the factors that affect anaesthesiologists’ practice are the number of sickle cell patients treated in the previous year, the surgical procedure that they are performing, and the perioperative period.
Surgical procedures that are performed in the perioperative period of sickle cell patients are associated with an increased complication rate. Consequently, the use of anaesthesia and postoperative management can be a challenge. During the perioperative phase, the main complication is a vaso-occlusive crisis (VOC). This complication can lead to acute chest pain syndrome, a stroke, and hypoxia.
Sickle cell arthropathy patients require specific resuscitation and hydration during the perioperative and postoperative periods. During these periods, opioid agonists should be used for severe pain management. However, they should not be used in patients with respiratory rates less than 10 breaths per minute. If a patient’s sedation is high, the use of these medications should be paused.
Sickle cell arthropathy and comorbidities are significant features of sickle cell disease (SCD). This is due to the fact that the genetic mutation that causes SCD causes a number of phenotypic expressions. While the specific manifestations vary from patient to patient, the common features are chronic pain, inflammation and osteoarticular complications.
Sickle cell arthropathy and rheumatoid arthritis are two examples of new comorbidities that have emerged with the recent development of medical advancements. The challenges involved in treating inflammatory arthritis associated with SCD are unique. In addition to the physical challenges that the disease presents, patients with SCD are also at risk of life-threatening infections.
Although the incidence of SCD is relatively low, its impact is significant. Its prevalence is about 8% in the United States. African-Americans and Mediterranean descents are the main demographics affected by the disease. However, it can affect individuals of all ethnic backgrounds.
People with SCD are immunocompromised. Therefore, they are at increased risk for infections, organ ischemia, and clotting. These factors contribute to the increase in the incidence of acute and chronic comorbidities.
A study conducted by Espinoza et al. studied 37 patients with non-gouty arthritis who had been diagnosed with SCD. Chronic synovitis was observed in 2 of the patients. Their study demonstrated the association between RA and SCD.
Medical advances have made it possible to improve the survival of people with SCD. For example, safer blood transfusions have resulted in an improvement in the overall health of sickle cell patients. Yet, the need for aggressive medical management of sicklings remains.
The transition from paediatric to adult care is a challenging period. Several factors make this more difficult, including the fact that fewer providers specialize in adult care. There is a growing need to recruit more providers and improve their understanding of the care needs of people with sickle cell.
As patients age, their comorbidities grow in complexity. They have to be treated throughout their lives. Some examples of comorbidities include gout, arthritis, vascular disorders, kidney failure, and stroke.
Comorbidities of sickle cell disease may occur at any age. In addition to orthopaedic complications, people with SCD have chronic pain and inflammation, as well as bone and soft tissue problems. In fact, people with SCD have an elevated risk of avascular necrosis of the bone and skeletal muscle, which can result in joint replacement.
People with sickle cell disease may have other symptoms or complications, such as diabetes, thyroid disease, and osteoporosis. People with the disease also have a higher risk of cardiovascular disease and chronic kidney failure.
Many of the comorbidities of SCD become more severe as people age. As a result, it is important for adults with the disease to have a physician or provider that can help them to manage their comorbidities.
Sickle cell arthropathy, or SCD, is an inflammatory disease that affects the joints. It is one of the most common inherited haematological disorders. Some of its complications can be painful and even life-threatening. Fortunately, most patients with SCD are able to lead relatively normal lives. Identifying and treating the symptoms and complications of SCD is essential to optimal outcomes.
One of the most common orthopaedic complications of sickle cell disease is osteomyelitis, which results in bone inflammation and injury. Osteomyelitis can be painful and cause significant problems, including loss of mobility and immobility. Because of the risk of infection, surgical treatment is often necessary for a patient with SCD.
Patients with SCD are at increased risk for a symptomatic stroke. In fact, ten per cent of all children with SCD will have a symptomatic stroke. Moreover, individuals with SCD are at high risk for other serious infections, such as meningitis and pneumonia. This is a reason why it is important to identify and treat these infections early.
Another complication of sickle cell disease is osteonecrosis. Osteonecrosis is a progressive condition that can affect the hips, shoulders, and feet. The most common clinical symptom of osteonecrosis is pain. While this pain can be mild and last for only a few hours, it can also be severe and require hospitalization.
Acute chest syndrome is a painful complication of sickle cell anaemia that causes chest pain. It can occur from either a bacterial or viral infection. When a person with SCD experiences a chest infection, the oxygen level in the blood drops, which can lead to breathing difficulty.
Chronic pain is another common symptom of sickle cell anaemia. Pain can be caused by a variety of factors, including stress, cold, and fever. Using a painkiller like L-glutamine oral powder can help ease the pain. But it’s important to remember that it’s impossible to eliminate all pain.
The first step to managing sickle cell anaemia is to prevent pain crises. Some of the ways to do this include taking daily hydroxyurea, which helps reduce the number of painful crises. Other therapies include leflunomide, etanercept, and infliximab.
It’s also important to know that some of the medications used for sickle cell disease are contraindicated for pregnant women. If you’re pregnant, talk to your doctor about the risks and benefits. Also, make sure that you take any prescribed medicines as directed.
There are a few other things you can do to prevent a crisis, such as avoiding extreme temperatures. Make sure that you’re getting enough rest and drink plenty of water. Keep your family informed about your illness. Get vaccines against pneumonia and meningitis. Getting a flu shot is a good idea.
Getting a regular transfusion can help reduce the severity of symptoms, especially when the body is not producing enough red blood cells. However, a transfusion can also increase the risk of developing an infection.
Arthropathy in Sickle-Cell Disease | Annals of Internal Medicine (acpjournals.org)
Osteoarticular involvement in sickle cell disease – PMC (nih.gov)