Chronic synovitis with early cartilage destruction in sickle cell disease

SUMMARY Two patients with sickle cell disease presented with joint pain and early x-ray evidence of articular cartilage loss. Both later developed increasingly destructive arthritis with chronic synovitis identified in synovial biopsies. One patient developed demonstrable aseptic necrosis. Destructive arthropathy is much less common than the frequent transient effusions in sickle cell disease. The most common arthropathy in sickle cell disease has consisted of transient noninflammatory effu-sions. These are often associated with crises and are suspected to be a result of microvascular occlusion in synovial, bone, or other periarticular tissues (Schumacher et al., 1973). Some joint effusions however are 'inflammatory ' with leucocyte count