Clinical prediction rules for the diagnosis of neuritis in leprosy

Abstract

Background Diagnosing neuritis in leprosy patients with neuropathic pain or chronic neuropathy remains challenging since no specific laboratory or neurophysiological marker is available. Methods In a cross-sectional study developed at a leprosy outpatient clinic in Rio de Janeiro, RJ, Brazil, 54 individuals complaining of neural pain (single or multiple sites) were classified into two groups (“neuropathic pain” or “neuritis”) by a neurological specialist in leprosy based on anamnesis together with clinical and electrophysiological examinations. A neurologist, blind to the pain diagnoses, interviewed and examined the participants using a standardized form that included clinical predictors, pain features, and neurological symptoms. The association between the clinical predictors and pain classifications was evaluated via the Pearson Chi-Square or Fisher’s exact test (p < 0.05). Results Six clinical algorithms were generated to evaluate sensitivity and specificity, with 95% confidence intervals, for clinical predictors statistically associated with neuritis. The most conclusive clinical algorithm was: pain onset at any time during the previous 90 days, or in association with the initiation of neurological symptoms during the prior 30-day period, necessarily associated with the worsening of pain upon movement and nerve palpation, with 94% of specificity and 35% of sensitivity. Conclusion This algorithm could help physicians confirm neuritis in leprosy patients with neural pain, particularly in primary health care units with no access to neurologists or electrophysiological tests.

Clinical, neurophysiological and histopathological profile of patients with neuropathic pain secondary to leprosy from a referral service in southeastern Brazil

“…10,[24][25][26][27] Recent studies suggest an annual prevalence of 15% of NP in leprosy patients, and it is known that this symptom has a great impact on patients' quality of life. 28 Although historically chronic pain syndromes are more prevalent among women, leprosy and NP are more frequent among men, 29 which is in agreement with what was found in our cohort, in which 55.6% of patients were male. Furthermore, the age group that reflects the economically active population is the most affected in many global studies on leprosy and NP, as confirmed in our study, in which the mean age of patients was 55 years.…”

Leprosy Reactions and Neuropathic Pain in Pure Neural Leprosy in a Reference Center in Rio de Janeiro – Brazil

“…The term neuritis has been used in numerous ways in the leprosy literature, sometimes describing the acute episode, as in a leprosy reaction, and sometimes as the silent nerve impairment caused by the disease (13). Limitations are present in this study, including the fact that the data is retrospective.…”

“…All of the patients with leprosy reactions were treated with corticosteroids. Neuropathic pain was always evaluated by a neurologist, and its diagnosis was based on the presence of pain in a neuro-anatomically plausible area with confirmed negative or positive sensory signs (13).…”

“…Silent or acute neuritis can result in nerve damage that may ultimately lead to the fearful disabilities (2). Neuropathic pain is characterized as a neural pain associated to dysfunction of the peripheral or central nervous sensory system that can be a consequence of neuritis (13). It has been estimated that there is an annual prevalence of 15% of neuropathic pain in leprosy patients and, although not usually included in the disability evaluation, this has a huge impact on the patients' quality of life (13).…”

Leprosy Neuropathy

“…Hasil positif menunjukkan bahwa pasien memiliki MB. Namun, hasil negatif tidak mengesampingkan diagnosis klinis kusta dan tidak serta merta mengklasifikasikan pasien sebagai penderita PB (3,6,7).…”