A patient presents with recurrent joint pain and swelling (including the knees) and has a history of splenectomy. Which condition best explains this picture?

Correct answer: D. Sickle cell anemia

• A. Behçet disease presents with recurrent oral and genital ulceration, uveitis and skin lesions. Arthritis occurs, but splenectomy is not part of the picture.
• B. Rheumatoid arthritis causes symmetric small-joint synovitis. Felty syndrome (RA plus splenomegaly and neutropenia) exists but is uncommon and would not be the best fit here.
• C. Osteoarthritis is a degenerative, non-inflammatory disease of older patients with no splenic association.
• D. CORRECT. SICKLE CELL ANEMIA produces vaso-occlusive crises that classically involve bone and joints, and it causes repeated splenic infarction leading to AUTOSPLENECTOMY — a functionally absent spleen, sometimes formalised by surgical removal. The combination of painful swollen joints plus a history relating to the spleen is the diagnostic pairing being tested. These patients are functionally asplenic and therefore at high risk from encapsulated organisms.

Note: Dental implications of sickle cell: avoid hypoxia and dehydration, treat infection aggressively, consider prophylaxis given functional asplenia, and expect a 'stepladder' trabecular pattern with possible mandibular infarcts on radiographs.