A case report of a patient who has pure red cell aplasia and rheumatoid arthritis

Pure red cell aplasia (PRCA) as an extra-articular manifestation of rheumatoid arthritis (RA) is rare. In the present report a 40-year-old female patient, with a 4-year-history of severe anemia and pain in the small joints of the hands, was diagnosed as having PRCA by bone marrow (BM) examination. Antihymocyte globulin (ATG), methylprednisolone and cyclosporin A (CSA) were used for the treatment of PRCA. The patient's hematological values responded within 60 months but pre-existing arthralgia continued, although with some relief. The patient subsequently fulfilled the criteria for diagnosis of RA at the 16th month. A review of nine published case reports on the coexistence of PRCA with RA revealed the initial diagnosis as RA. In our case, as the initial symptoms and findings were not sufficient for the diagnosis of RA, we therefore conclude that PRCA preceded RA. Although CSA was curative in the treatment of PRCA it could not prevent the full diagnostic features of RA.