Anticardiolipin antibodies in patients with rheumatoid arthritis.

Anticardiolipin antibodies (ACA) were assayed by ELISA in 73 patients with rheumatoid arthritis. Twelve (16.48%) patients showed levels of ACA three standard deviations above the value of the control group and were considered positive; these patients were compared to the group with ACA within the normal levels regarding the following clinical and laboratorial characteristics: spontaneous abortions, central nervous system involvement, systematization and activity of disease, alterations in platelet counts, presence of antinuclear antibodies and rheumatoid factor. Significant statistical association could be demonstrated between systematization and presence of antinuclear antibodies (ANA) and positiveness to ACA (IgG, IgM or both). These findings might indicate that ACA in patients with RA could have relevance to morbidity of disease or perhaps to its pathogenesis.

Possible mechanisms of chronic leprosy-related arthritis.

Microbial agents induce arthritis through mechanisms such as direct infiltration of tissue and by inducing autoimmune phenomena. The mechanisms involved in this last type of arthritis have been investigated. In experimental models of adjuvant and reactive arthritis, the involvement of T cells in some cases mycobacteria in the development of arthritis have been confirmed. Cross-reactivity between the 65 kD mycobacterial protein and cartilage proteoglycans has been postulated as a possible mechanism. In this study, chronic peripheral arthritis was observed in patients with Hansen's disease, in patients with resolved Hansen's and in those with paucibacillary forms. This arthritis was not related to reactional states (erythema nodosum leprosum and reversal reaction), in contrast to several reports in the literature. The mechanisms by which microbes could induce chronic arthritis are discussed herein.

Humoral immunity in Hansen's disease.

For many years immune response in leprosy has been studied. Since 1960 several reports dealing with humoral immunity have been described in the literature. Different autoantibody rates occur in leprosy. There is an increase in the prevalence of autoantibodies in elderly patients with long standing disease, in lepromatous leprosy and in those with reactional states. The differences in rates among various studies are attributed to different methods and variations among patient samples concerning age, gender, polar forms, therapy and other elements. The prevalence of numerous antibodies, immune complexes, cryoglobulins and complement levels have been studied by many authors. This also highlights the importance of the more recent reviews of anti-Mycobacterium leprae glycolipid antibodies such as the anti-phenolic glycolipid-I antibodies in which titers are variable and depend on genetic factors.

Leprosy: statistics in the Americas.

While leprosy is a major problem in many countries, and an effective vaccine is still to come, improvement of public health methods appears to be, in addition to antileprosy drugs, the most meaningful solution. Widely diverging social, economic and environmental factors and differences in public health programs among regions, contribute to the uneven distribution of leprosy throughout the American continent.

[Reactive arthritis and its etiopathogenic mechanisms]. / Artrite reativa e seus mecanismos etiopatogênicos.

The reactive arthritis is an important clinical entity, which is under intense scientific investigation particularly in what concerns to the infective agent and the immunological mechanisms involved in its pathogenesis. The infective agents, as well as the antigens and the cellular immune response lead to arthritis after a sequence of events. Some important aspects, such as the genetic predisposition of some individuals, the intracellular life cycle of the bacteria, the mucosal membranes as the site of penetration of the infectious agent, as well as the lipopolysaccharide as the most important component of the membrane, are extensively discussed. The importance of better understanding this disease will end up in the amelioration of therapeutic approach.

Rheumatic manifestations of leprosy: clinical aspects.

Articular manifestations had been identified in leprosy in ancient times. However, for the last 5 decades, the focus has been on inflammatory changes resembling rheumatologic diseases. Better understanding of these manifestations is important both to improve therapy and to clarify the pathogenetic mechanisms involved in leprosy.

[Rheumatic involvement in Hansen's disease]. / Os comprometimentos reumatológicos na hanseníase.

The classical articular manifestations of Hansen's disease are the neurogenic or Charcot's arthropathy, osteitis and specific or non specific osteoarthritis. However, inflammatory mechanisms have been associated to arthritic episodes in leprosy patients, leading to rheumatoid-like picture as suggested by clinical, biopsy and laboratorial data. The extra-articular manifestations also mimicry those of some connective tissue diseases. The differencial diagnosis between rheumatic syndromes and hanseniasis is important for as early indentification of hanseniasis and prevention of severe sequelae and transmission.

Articular inflammatory manifestations in patients with different forms of leprosy.

OBJECTIVE: To study the articular inflammatory manifestations of leprosy. METHODS: Sixty patients with leprosy from a public clinic in São Paulo, Brazil, participated in a study regarding their articular manifestations. The diagnosis and classification of leprosy were established by the clinical picture, skin smears, skin biopsy, and delayed hypersensitivity test to Mycobacterium leprae antigens (Mitsuda test). According to the Madrid and Ridley-Jopling classifications, 46 patients had lepromatous leprosy, 7 had borderline leprosy, 4 had tuberculoid leprosy, and 3 had indeterminate leprosy. History, general and articular examinations, and roentgenograms were employed and complemented in several cases by scintigraphic examinations with technetium methylene diphosphonate and computed tomographic studies. RESULTS: Three patients were excluded from study due to an association with a rheumatic disease. Among the 57 remaining patients, 44 had peripheral arthritis characterized by involvement of small joints (23/44), large joints (4/44), or both (17/44). The mean duration of arthritis was 11 years (range 1 mo to 51 yrs). Arthritis was detected in all subtypes of patients with leprosy. Supplementary radiological evaluation established the extent of inflammation and diagnosis of sacroiliitis. The diagnosis of sacroiliitis, based on the presence of sclerosis, erosions, and narrowing of the cartilage space in the sacroiliac joints, was established in 35 of 55 radiographs. Sacroiliitis varied from grade I to III, according to the Bennet and Wood classification, and was bilateral in most cases (30/35). There was no significant correlation between low back pain and the finding of sacroiliitis. CONCLUSION: Articular inflammatory manifestations may exist in patients with different forms of leprosy, and can follow a chronic course. In addition, sacroiliitis is a common, previously unrecognized manifestation in patients with leprosy.