OBJECTIVE:To analyze predictive factors in the progression of the disability grade in patients with leprosy.METHODS: A retrospective cohort study followed up 595 patients with disability registered at a healthcare unit in the city of Belo Horizonte (Southeastern Brazil) from 1993 to 2003. Patients' sociodemographic and clinical information was collected from the respective medical records. Comparisons were made between the disability grade upon admission and at the end of treatment using a marginal homogeneity test. To determine factors associated with progression in the disability grade, univariate analysis (linear trend chi-square test) was employed, as well as multivariate analysis by means of the algorithm Chi-square Automatic Interaction Detector. RESULTS:Among the cases in which the disability grade was recorded upon admission and upon discharge, 43.2% of the patients who had grade 1 in the fi rst assessment progressed to grade 0. Among those who began with grade 2, 21.3% progressed to grade 0 and 20% progressed to grade 1. In the univariate analysis, the variables that proved to be statistically associated with progression in the disability grade were: neuritis, time elapsed until the occurrence of neuritis, number of damaged nerves, type of physiotherapy treatment and higher dose of prednisone. In the multivariate analysis, the main factor associated with the progression of disability was the disability grade upon admission. CONCLUSIONS:The results showed the importance of an early diagnosis of neuropathy as well as the effi cient association of pharmacological and non-pharmacological treatment, through disability prevention techniques and adequate doses of steroid.

Revista da Sociedade Brasileira de Medicina Tropical 41(5):464-469, set-out, 2008 ARTIGO/ARTICLEA hanseníase é identificada, caracterizada e temida pelo seu alto potencial deformante. Seu agente etiológico, o Mycobacterium leprae, é um bacilo hospedeiro intracelular obrigatório (tropismo por células nervosas, bainha de Schwann), podendo provocar inflamações, reações imunológicas e processos compressivos que podem evoluir de uma neuropraxia a uma neurotmese, ou seja, de um dano neural leve e transitório a uma lesão completa e irreversível do nervo. O comprometimento dos nervos periféricos é a característica principal da doença podendo, acarretar ao paciente, deficiências e incapacidades, diminuindo sua ABSTRACTNeuritis in leprosy cases is responsible for deformities and disability. The objective of this historical cohort study was to investigate the risk factors associated with the time taken for neuritis to occur. This study followed up 595 patients from 1993 to 2003. The life table technique and the Kaplan-Meier method for survival curves were used. The log-rank test was used to test differences between groups regarding the time take for neuritis to occur, and the Cox regression model was used to estimate the hazard ratios. Just over half (54%) of the sample had neuritis, which had mostly taken 0 to 11.9 months to appear. The degree of disability at admission and the bacillary index were strongly associated with the occurrence of neuritis, thus confirming the need for early diagnosis of leprosy, as well as regular neurological follow-up and appropriate interventions.Key-words: Leprosy. Neuritis. Risk factors.incapacidades nesses pacientes. Sua fisiopatologia ainda é pouco conhecida, apesar de várias investigações recentes sobre este tema 1 10 11 13 15 17 18 . As neuropatias refletem o processo inflamatório acompanhado de resposta imune, que pode ocorrer nos nervos periféricos, após a infecção pelo Mycobacterium leprae. O monitoramento da função neural, o diagnóstico precoce e as intervenções adequadas são essenciais à preservação da estrutura e função do nervo periférico, contribuindo para evitar as incapacidades 3 4 16 . O presente estudo teve como objetivo investigar os fatores de risco associados ao tempo até a ocorrência do primeiro episódio de neurite, após iniciar poliquimioterapia, identificando e comparando possíveis preditores de sua ocorrência.

A hanseníase é uma doença infectocontagiosa, de evolução lenta, provocada pelo Mycobacterium leprae, ou bacilo de Hansen, que se manifesta, essencialmente, por meio de sinais e sintomas dermatoneurológicos: lesões de pele e de nervos periféricos, principalmente nos olhos, mãos e pés1,2 .