Arthritis in leprosy

Chauhan, Sandeep; Wakhlu, Anupam; Agarwal, Vikas

doi:10.1093/rheumatology/keq264

Cited by 76 publications

(94 citation statements)

References 12 publications

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“…A study of 202 brucellar arthritis cases reported the involvement of the SI joint in 60.6% of cases. Furthermore, leprosy may also affect the SI, mimicking spondylarthropathy [25]. …”

Section: Discussionmentioning

confidence: 99%

Infectious sacroiliitis: a retrospective, multicentre study of 39 adults

et al. 2012

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BackgroundNon-brucellar and non-tuberculous infectious sacroiliitis (ISI) is a rare disease, with misleading clinical signs that delay diagnosis. Most observations are based on isolated case reports or small case series. Our aim was to describe the clinical, bacteriological, and radiological characteristics of ISI, as well as the evolution of these arthritis cases under treatment.MethodsThis retrospective study included all ISI cases diagnosed between 1995 and 2011 in eight French rheumatology departments. ISI was diagnosed if sacroiliitis was confirmed bacteriologically or, in the absence of pathogenic agents, if clinical, biological, and radiological data was compatible with this diagnosis and evolution was favourable under antibiotic therapy.ResultsOverall, 39 cases of ISI were identified in adults, comprising 23 women and 16 men, with a mean age at diagnosis of 39.7 ± 18.1 years. The left sacroiliac joint (SI) was affected in 59% of cases, with five cases occurring during the post-partum period. Lumbogluteal pain was the most common symptom (36/39). Manipulations of the SI joint were performed in seven patients and were always painful. Mean score for pain using the visual analogue score was 7.3/10 at admission, while 16 patients were febrile at diagnosis. No risk factor was found for 30.7% of patients. A diagnosis of ISI was only suspected in five cases at admission. The mean time to diagnosis was long, being 43.3 ± 69.1 days on average. Mean C-reactive protein was 149.7 ± 115.3 mg/l, and leukocytosis (leukocytes ≥ 10 G/l) was uncommon (n = 15) (mean level of leukocytes 10.4 ± 3.5 G/l). Radiographs (n = 33) were abnormal in 20 cases, revealing lesions of SI, while an abdominopelvic computed tomography (CT) scan (n = 27) was abnormal in 21 cases, suggesting arthritis of the SI joints in 13 cases (48.1%) and a psoas abscess in eight. Bone scans (n = 14) showed hyperfixation of the SI in 13 cases. Magnetic resonance imaging (MRI) (n = 27), when focused on the SI (n = 25), directed towards the diagnosis to ISI in 25 cases. Pathogenic agents were isolated in 33 cases (84.6%) by means of articular puncture (n = 16), blood culture (n = 14), cytobacteriological examination of urine (n = 2), or puncture of the psoas (n = 1).Gram-positive cocci were the mostly isolated common bacteria, with a predominance of staphylococci (n = 21). The most frequently isolated gram-negative bacillus was Pseudomonas aeruginosa (n = 3). Evolution was favourable in 37 out of 39 patients under prolonged antibiotic therapy (mean duration 3.01 ± 1.21 months).ConclusionOur series confirmed that the clinical manifestations of ISI usually lead to delayed diagnosis. Based on our results, we suggest performing an MRI of the spine and SI in clinical situations characterised by lumbogluteal pain and symptoms of an infectious disease, such as fever.

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“…A study of 202 brucellar arthritis cases reported the involvement of the SI joint in 60.6% of cases. Furthermore, leprosy may also affect the SI, mimicking spondylarthropathy [25]. …”

Section: Discussionmentioning

confidence: 99%

Infectious sacroiliitis: a retrospective, multicentre study of 39 adults

et al. 2012

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“…Other rheumatological manifestations occasionally reported are enthesitis, sacroiliitis, vasculitis, etc. [5859] Often, in lepromatous leprosy, antinuclear antibodies may also be weakly positive and may complicate the clinical picture. The authors have encountered Hansen's disease presenting with different clinical manifestations mimicking vasculitis, lupus, sarcoidosis, etc.…”

Section: Arthritis Associated With Infectionsmentioning

confidence: 99%

Arthropathy in dermatology: A comprehensive review

Jagadeesan

Shenoy²

2017

Indian Dermatol Online J

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Dermatology and rheumatology are two specialties that deal with significant overlap. In this context, it is important that the dermatologists acquaint themselves with conditions presenting with arthropathy. As the first step, it is essential to know whether the origin of musculoskeletal symptom is articular or extra-articular; inflammatory or noninflammatory; acute or chronic; oligo- or poly-articular. This will help in narrowing down the differential diagnoses as well as in better correlation with the cutaneous symptoms. In this review, we discuss the skin and articular manifestations of common inflammatory and noninflammatory arthropathies including rheumatoid arthritis, spondyloarthropathies, connective tissue disorders, vasculitis, crystal arthropathies, infective arthritis, arthritis associated with degenerative, endocrine and metabolic conditions, etc. We have also added a section on the common cutaneous features associated with the treatment of rheumatologic diseases. A basic understanding of the joint pathologies and associated skin changes will help a long way in the better management of these conditions.

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“…Rheumatological manifestations are seen in 1% to 70% of patients, resulting in clinical presentations of acute inflammatory arthritis, chronic symmetrical polyarthritis mimicking rheumatoid, Charcot's arthropathy, swollen hands and feet syndrome, tenosynovitis, vasculitis, lupus-like illness, and so forth [4, 5]. In addition various autoantibodies like antinuclear antibodies (ANA) and rheumatoid factor (RF) may be positive in leprosy, increasing the chances of misdiagnosis as a true autoimmune disease resulting in inappropriate treatment with immunosuppressive therapy [5]. …”

Section: Introductionmentioning

confidence: 99%

Leprosy with Atypical Skin Lesions Masquerading as Relapsing Polychondritis

Pruthi

Munganda

Bangia

et al. 2016

Case Reports in Infectious Diseases

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Leprosy can present with a variety of clinical manifestations depending on the immune status of the individual. After dermatological and neurological involvement, rheumatic features specially various forms of arthritis are the third most common manifestation of the disease. We describe a unique case of a 22-year-old patient presenting with external ear involvement mimicking relapsing polychondritis along with inflammatory joint symptoms and skin lesions. Ear involvement in relapsing polychondritis characteristically is painful and spares the noncartilaginous ear lobules, in contrast to painless ear involvement in leprosy affecting the lobules as well. Histopathology confirmed the diagnosis, although the ear and skin lesions were not classical of leprosy. Such a presentation of leprosy closely mimicking relapsing polychondritis has not been described previously. Tissue diagnosis should always be attempted whenever possible in patients presenting with autoimmune features, so that inappropriate therapy with immunosuppressants is avoided.

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Arthritis in leprosy

Cited by 76 publications

References 12 publications

Infectious sacroiliitis: a retrospective, multicentre study of 39 adults

Infectious sacroiliitis: a retrospective, multicentre study of 39 adults

Arthropathy in dermatology: A comprehensive review

Leprosy with Atypical Skin Lesions Masquerading as Relapsing Polychondritis

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