Arthritis in beta thalassaemia trait: clinical and pathological features.

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Abstract
A 33 yr old white female of English descent with .beta. thalassemia trait developed painful recurring bilateral knee effusions at age 15 yr. Trauma was denied. Synovial analyses revealed noninflammatory effusions with normal complement, no inclusions and no crystals. Knee X-rays, normal at ages 18 and 26, showed mild osteoarthritic changes at age 33. Laboratory tests for other known causes of arthritis were repeatedly normal or negative. Bone densitometry was below normal. Light microscopy of the synovial membrane showed no significant abnormalities and no iron deposition. EM findings included multilamination of vascular basement membranes and large amounts of thin fibrils surrounding many connective tissue cells. Treatment with salicylates did not prevent recurrence of effusions, and quadriceps strengthening and joint rest were moderately successful in relieving pain. Intra-articular corticosteroids on 2 occasions were not helpful. It is unknown if her knee arthritis is purely secondary to the para-articular bone thinning from chronic marrow expansion.