Bilharzial arthropathy: Rare cause of chronic arthritis in tropical areas

Background. Schistosomiasis is an endemic parasitic infection found in many tropical countries and is highly prevalent in sub-Saharan Africa. It can follow different and atypical clinical patterns. In these unusual cases, diagnosis may be difficult, as symptoms are unspecific. Arthropathy can appear in parasitic infections, but making a connection between arthritis and parasitic aetiology is difficult. This review aims to summarise all cases that have reported schistosomiasis associated with arthropathy, and the different ways authors have diagnosed this disease. Method. We present a systematic literature review of schistosomiasis associated with joint impairments, with a focus on the difficulty of differentiating between reactive arthritis and its parasitic presence in situ. Results. Joint impairments mimicking polyarthropathy are not rare in parasitic infections. Diagnosis is difficult. On the one hand, some patients have arthritis with parasite eggs found in situ, particularly in synovial biopsy. These situations are less common and antiparasitic treatment is straightforward. On the other hand, arthritis can be associated with parasitic infections in the form of reactive arthritis due to an immunological reaction. In such cases, pathogenicity due to circulating immune complex should be suspected. Anti-inflammatory treatments such as corticosteroids or immunosuppressive therapies are ineffective in cases of schistosomal arthropathy. A joint fluid puncture appears to be necessary and parasitic examination as well as in situ immunological techniques appear to be important in order to confirm the diagnosis of schistosomal arthropathy. Conclusions. The frequency of articular schistosomiasis is probably underestimated and should be sought when patients have unexplained polyarthropathy, as it can be an alternative diagnosis when patients have concomitant parasitic infections. These situations are common, whereas the association between unexplained inflammatory arthritis and a concomitant parasitic infection is rarely made. Unspecific rheumatism can lead to probabilistic treatments with many side effects, and looking for a parasitic aetiology could lead to repeated antiparasitic treatments and may avoid other immunosuppressive or corticosteroid therapies. With increasing travel and global migration, physicians need to be more aware of nonspecific symptoms that may reveal an atypical presentation of a tropical disease that can be treated easily, thus avoiding inappropriate immunosuppressive treatments.

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“…This clinical evolution led the authors to conclude that these were cases of parasitic arthropathy. X-rays were normal in both cases [9].…”

Section: Review Of the Literature On Articular Schistosomiasismentioning

confidence: 86%

“…More recently, Rakotomala et al reported two cases of chronic joint pain in Madagascar [9]. They were two similar clinical patterns of chronic arthritis, mainly lumbar and sacroiliac, which were resistant to anti-inflammatory treatments.…”

Section: Review Of the Literature On Articular Schistosomiasismentioning

confidence: 99%

Schistosomiasis and Recurrent Arthritis: A Systematic Review of the Literature

et al. 2022

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Parasitic Arthritis

Márquez-Hernández¹

2019

Infections and the Rheumatic Diseases

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The Crucial Questions on Synovial Biopsy: When, Why, Who, What, Where, and How?

et al. 2021

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In the majority of joint diseases, changes in the organization of the synovial architecture appear early. Synovial tissue analysis might provide useful information for the diagnosis, especially in atypical and rare joint disorders, and might have a value in case of undifferentiated inflammatory arthritis, by improving disease classification. After patient selection, it is crucial to address the dialogue between the clinician and the pathologist for adequately handling the sample, allowing identifying histological patterns depending on the clinical suspicion. Moreover, synovial tissue analysis gives insight into disease progression helping patient stratification, by working as an actionable and mechanistic biomarker. Finally, it contributes to an understanding of joint disease pathogenesis holding promise for identifying new synovial biomarkers and developing new therapeutic strategies. All of the indications mentioned above are not so far from being investigated in everyday clinical practice in tertiary referral hospitals, thanks to the great feasibility and safety of old and more recent techniques such as ultrasound-guided needle biopsy and needle arthroscopy. Thus, even in rheumatology clinical practice, pathobiology might be a key component in the management and treatment decision-making process. This review aims to examine some essential and crucial points regarding why, when, where, and how to perform a synovial biopsy in clinical practice and research settings and what information you might expect after a proper patient selection.

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Bilharzial arthropathy: Rare cause of chronic arthritis in tropical areas

Cited by 3 publications

References 6 publications

Schistosomiasis and Recurrent Arthritis: A Systematic Review of the Literature

Schistosomiasis and Recurrent Arthritis: A Systematic Review of the Literature

Parasitic Arthritis

The Crucial Questions on Synovial Biopsy: When, Why, Who, What, Where, and How?

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