RESUMEN
Deformities of bones of the face and extremities are markers of leprosy (Hansen's disease) which contribute to stigma associated with this disease. Among these deformities are articular alterations that can mimic rheumatoid arthritis (RA). In this case, a 64-year-old man presented with a history of having been treated for lepromatous leprosy and erythema nodosum leprosum episodes, which evolved with joint alterations similar to those of RA. Most cases of leprosy-related arthritis are associated with reactional episodes, of which a large number do not respond to conventional therapy for leprosy reactions. In cases of chronic arthritis not associated with leprosy reactions, although patients show considerable relief with anti-leprosy therapy, arthritis is not completely resolved. This emphasizes the need for early diagnosis and treatment of leprosy to prevent the development of osteoarticular alterations.
Asunto(s)
Artritis Reumatoide/patología , Articulaciones/patología , Lepra Lepromatosa/diagnóstico , Lepra Lepromatosa/patología , Humanos , Masculino , Persona de Mediana EdadRESUMEN
No presente trabalho, revisamos as manifestacoes reumatologicas que ocorrem na hanseniase, incluindo as osteoarticulares, extra-articulares e laboritoriais. Alem dos envolvimentos osteo articulares classicos na hansenise como a artropatia neurogenica ou de Charcot a osteite e a osteoartrite septica especifica ou inespecifica, outros quadros articulares de natureza inflamatoria tem sido relatados, associados ou nao a estados reacionais (reacao reserva e eritema nodoso leproso) da hanseniase. O envolvimento extra-articular pode repetir varias das manifestacoes presentes nas doencas difusas do tecido conectivo, sendo importantes para o diagnostico diferencial e terapeutica.
Asunto(s)
Artritis Reumatoide/patología , Lepra/diagnóstico , Huesos/anomalías , Diagnóstico Diferencial , Lepra/complicaciones , Lepra/inmunologíaAsunto(s)
Artritis Reumatoide/tratamiento farmacológico , Encefalomielitis Autoinmune Experimental/tratamiento farmacológico , Hipersensibilidad/tratamiento farmacológico , Neuritis/tratamiento farmacológico , Talidomida/uso terapéutico , Animales , Artritis Reumatoide/etiología , Artritis Reumatoide/patología , Modelos Animales de Enfermedad , Evaluación de Medicamentos , Encefalomielitis Autoinmune Experimental/etiología , Encefalomielitis Autoinmune Experimental/patología , Adyuvante de Freund/efectos adversos , Granuloma/tratamiento farmacológico , Cobayas , Hipersensibilidad/etiología , Hipersensibilidad/patología , Mycobacterium/inmunología , Mycobacterium tuberculosis/inmunología , Neuritis/etiología , Neuritis/patología , Ratas , Especificidad de la EspecieRESUMEN
The pathology of the synovial membrane in rheumatoid arthritis can be characterized by the prominence of two major features which appear to vary independently of one another. These are synovial lining-cell proliferation and infiltration with inflammatory cells, predominantly lymphocytes. In a series of 42 synovectomies from 36 patients it has been shown that extensive joint damage is associated with a synovial picture of marked lining-cell proliferation and a sparsity of lymphocytes. Cases with heavy lymphocyte infiltration tend to show less damage to articular cartilage and bone despite a similar duration of disease. These results have been compared with the picture in leprosy, where a similar pathological spectrum is associated with changes in cell-mediated immunity necessary for the control of infection.