Painful Episodes in Children with Sickle Cell Disease: Could It Be an Osteoarticular Infection?

Background: In children with sickle cell disease (SCD) episodes of bone and joint pain can be common, frequently in the context of vaso-occlusive crisis (VOC). However, these children are also more susceptible to bacterial infections, including osteomyelitis and septic arthritis. Distinguishing between these entities can often prove to be a challenge.

Objective: Characterise painful episodes, secondary to VOC and osteoarticular infections, in a cohort of children with sickle cell disease, and establish differences between the two groups.

Methods: Retrospective study of emergency room visits from 1st January 2015 to 31st December 2019, in SCD patients between 0 and 18 years-old. Episodes that included bone and joint pain, not caused by trauma, were selected and analysed. Image studies were reviewed when the diagnosis was not clear. Statistical analysis was performed with SPSS 26® (significance level p<0,05).

Results: Of the 131 emergency room visits selected we identified 8 cases of osteoarticular infection (6,1%). All the patients with osteoarticular infections were admitted to the hospital in comparison to 57,7% of children with VOC (p 0,022). Length of stay was longer in the group with osteomyelitis/septic arthritis (p 0,008) and this group required more frequently central venous catheterisation (p 0,010).

Fever at admission was present in just one case of osteoarticular infection (12,5%). We did not identify statistically relevant differences between the two groups concerning age (p 0,699), C - reactive protein at presentation (p 0,062), haemoglobin value at presentation (p 0,554) or requirement for erythrocyte transfusion (p 1,000).

Conclusion: Osteoarticular infections are an important cause of morbidity in children with SCD, requiring long antibiotic treatments and prolonged hospital stay. However, clinical features and laboratory tests at presentation can be very similar to those found on VOC. Therefore, a high index of suspicion is needed when approaching a child with SCD and bone pain.