Case Report: Leprosy Osteoarticular Alterations Mimicking Rheumatoid Arthritis.

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.

Rheumatoid arthritis-like features in Hansen disease: A case report.

RATIONALE: Hansen disease is an infectious chronic disease with various clinical manifestations. Its joint performance may easily mimic rheumatoid arthritis. PATIENT CONCERNS: We report a case of a 57-year-old woman diagnosed with Hansen disease 10 years ago, who suffered from joints swelling, pain and joints deformities of both hands for 19 years. The skin on the hands showed rashes, thickening, desquamation and chapping, with both thenar muscles atrophy. She also had severe hypoalgesia of the whole body, and morning stiffness for one hour. DIAGNOSES: The final diagnosis was joint damage and peripheral neuropathy due to Hansen disease. INTERVENTIONS: The patient received neurotrophic treatment instead of anti-rheumatic treatment. OUTCOMES: At 1-year follow up, no further aggravation of joint swelling and pain was detected. LESSONS: The correct diagnosis of Hansen disease involving joints depends on the combination of medical history, careful physical examination, and laboratory examination.

Diagnóstico tardío de lepra lepromatosa. A propósito de un caso / No disponible

La lepra es una enfermedad infecciosa crónica, que afecta piel y nervios periféricos, la mucosa de las vías respiratorias superiores y también los ojos, además de algunas otras estructuras, ocurre en personas de cualquier edad y de ambos sexos causadas por el Mycobacterium leprae. El diagnóstico precoz reviste gran importancia ya que cura al enfermo, interrumpe la cadena de transmisión y evita las discapacidades. Presentamos un paciente masculino de 46 años de edad, trabajador agrícola sin antecedentes epidemiológicos conocidos y sin percepción del riesgo de la enfermedad que ingresa en el hospital municipal de Florida con fiebre, dolores articulares y lesiones en piel, diagnosticándose una lepra lepromatosa, discapacidad grado 2 según clasificación de la OMS dado por la deformidad de manos y pies, la pérdida de la estructura y la rigidez, constituyendo un diagnóstico tardío

Leprosy is an infectious disease with a chronic evolution that affects skin, peripheral nerves, upper respiratory tract and other structures. It appears in individuals of any age or sex and its etiological agent is Mycobacterium leprae. An early diagnosis is essential for preventing incapacities and interrupting the chain of transmission. We present a case of a 46 year old male, field worker, with a previous clinical history and no reception of the risk of illness. He entered the general hospital in Florida with fever, joint pains and skin lesions and was diagnosed of lepromatous leprosy, with grade 2 disabilities according to the WHO classification of the hand, feet and eye deformities, all the cause of a late diagnosis

Leprosy-related joint involvement.

We estimate the prevalence and evaluate the clinical characteristics of leprosy related arthritis. One thousand, two hundred fifty-seven leprosy patients were attended at "Alfredo da Matta" outpatient clinic in the state of Amazonas, Brazil from July to October 2004. Among them, 115 patients were identified with articular pain and were referred for evaluation with rheumatologist. Blood samples were collected and radiological evaluation of the involved joints was performed. All patients with arthritis who continued to be followed up were reevaluated. One hundred fifteen leprosy patients (9.1%) were identified with articular involvement. The articular complaints were attributed to a defined rheumatic disease in 36 cases and excluded from further analysis. Twenty-four patients had arthralgia, and 55 (37 males and 18 females) had leprosy-related arthritis. The prevalence of arthritis was similar in both genders, and all patients with leprosy-related arthritis had lepromatous or borderline type. Most of patients had polyarticular and symmetrical arthritis and had completed the multidrug therapy and was under reaction treatment. The mean duration of articular symptoms at the time of study was 1.06 years (ranging from 5 days to 14 years). Ninety-one percent of patients with leprosy-related arthritis presented erythema nodosum leprosum or reversal reactions. Only five patients with arthritis had never presented reactions. Fifty percent of patients became asymptomatic during the mean 24 months of follow-up. Leprosy-related arthritis has a lower prevalence than previously reported. Most cases of leprosy-related arthritis were associated with reactional episodes, and in a large number of cases, the arthritis had a chronic course not responsive to the conventional therapy for reactions.

Alterações óssea e articulares na hanseníase / Bone and joint changes in leprosy

Objetivou-se o presente trabalho de modo a contribuir para a prevenção, o diagnóstico precoce e tratamento apropriado das lesões ósseas e articulares na hanseníase, reduzindo o impacto mundial das doenças deformantes e mutilantes. Assim, foi realizada uma série de estudos retrospectivos longitudinais e de corte transversal em pacientes recém diagnosticados com Hanseníase ou que receberam poliquimioterapia (PQT) em dose fixa, com o fim de avaliar as osteoartropatias e seus mecanismos fisiopatogênicos. Foi observada uma progressão das acropatias ósseas durante e após a PQT. Em uma amostra de 93 pacientes multibacilares tratados, observou-se, clinicamente, uma prevalência de 7,5 por cento de absorção nas extremidades. Ao incluir os dados radiológicos na análise de 105 pacientes, a prevalência aumentou para 21,7 por cento. A progressão das acropatias encontrou-se associada à neuropatia periférica e suas complicações, à presença de episódios reacionais crônicos e à manutenção de níveis séricos elevados de fator de necrose tumoral alfa. A reabsorção óssea persistiu ativa em 50 por cento dos 30 pacientes avaliados após 5 anos do fim da PQT. Em pacientes com episódios reacionais prolongados ou recorrentes, avaliados com técnicas de medicina nuclear, detectaram-se freqüentes alterações ósseas e articulares principalmente de natureza inflamatória e uma elevada prevalência (27 por cento) de osteoporose lombar. Nestes pacientes, as áreas de predomínio de osso trabecular foram mais afetadas por osteopenia, enquanto nos pacientes virgens de tratamento avaliados, observou-se osteopenia predominantemente em áreas de osso compacto (80 por cento dos pacientes). Os supracitados resultados sugerem que a reação imunoinflamatória é um fator importante envolvido no acometimento ósseo e articular na hanseníase, a qual age isoladamente ou em conjunto com os mecanismos de natureza infecciosa, neurológica e vascular. Os pacientes com neuropatia periférica e episódios reacionais recorrentes devem ser acompanhados e avaliados radiologicamente após a alta terapêutica.

Geographically specific infections and arthritis, including rheumatic syndromes associated with certain fungi and parasites, Brucella species and Mycobacterium leprae.

This overview is designed to introduce the reader to the broad spectrum of rheumatic syndromes associated with certain fungal and parasitic diseases, brucellosis and leprosy. Musculoskeletal disorders caused by fungi are uncommon and difficult to diagnose, particularly in the early stages. Deep fungal infections involve-in order of frequency-bone, soft tissues and joints. Rare but well-defined rheumatic syndromes occur in a variety of parasitic diseases. Brucellosis remains a major challenge to both human public health and clinical acumen in many countries today. The arthritis of leprosy deserves wider recognition and study as it contributes to disability and may hold clues to the mechanism of inflammation in other rheumatic disorders. All of the above may afflict residents in endemic areas and occasionally appear far from the source of origin in travellers or migrants, and usually cause diagnostic confusion.

Geographically specific infections and arthritis, including rheumatic syndromes associated with certain fungi and parasites, Brucella species and Mycobacterium leprae

This overview is designed to introduce the reader to the broad spectrum of rheumatic syndromes associated with certain fungal and parasitic diseases, brucellosis and leprosy. Musculoskeletal disorders caused by fungi are uncommon and difficult to diagnose, particularly in the early stages. Deep fungal infections involve-in order of frequency-bone, soft tissues and joints. Rare but well-defined rheumatic syndromes occur in a variety of parasitic diseases. Brucellosis remains a major challenge to both human public health and clinical acumen in many countries today. The arthritis of leprosy deserves wider recognition and study as it contributes to disability and may hold clues to the mechanism of inflammation in other rheumatic disorders. All of the above may afflict residents in endemic areas and occasionally appear far from the source of origin in travellers or migrants, and usually cause diagnostic confusion.

Comparative evaluation of effectiveness of different motor muscles in modified lasso procedure for correction of finger clawing

A retrospective study was carried out to compare the effectiveness of different muscles as motors in modified lasso procedures for correction of finger clawing in leprosy. It was observed that palmaris longus and extensor carpi radialis longus were more suitable than the flexor digitorum superficialis. In some patients, removal of superficialis is associated with complications which could not be predicted before surgery. Extensor carpi radialis longus has advantages over palmaris longus in selected cases.

A monoclonal antibody to the mycobacterial 65 kDa heat shock protein (ML 30) binds to cells in normal and arthritic joints of rats.

A monoclonal antibody reactive with the mycobacterial 65 kDa heat shock protein (ML 30) was investigated for reactivity with biopsies from normal rat joints and with inflamed joints due to adjuvant arthritis (AA) or collagen induced arthritis (CIA). Immunohistochemical stainings with the anti-hsp 65 antibody on paraffin sections from normal rat joints revealed a weak but exclusive staining of cells within the synovial lining. Also normal chondrocytes and bone marrow cells showed occasional staining. In biopsies from inflamed joints obtained from rats suffering from AA or CIA, an intense staining with ML 30 was seen within the cartilage-pannus junction as well as sites of bone erosion. An increased staining, compared with the normal, was also seen in chondrocytes of the eroded cartilage and in some bone marrow cells. No staining with ML 30 was seen in biopsies from inflammatory lesions due to delayed type hypersensitivity reactions in the skin of rats. Reactivity of ML 30 was also seen in a Western blot assay performed on lysates from inflamed synovia from rats with CIA, preferentially with a component slightly below 60 kDa in molecular weight. The demonstration of epitopes cross-reactive with hsp 65 of mycobacteria in normal and, in higher quantity, in arthritic rat joints, suggests, together with our preliminary biochemical findings, that a recently identified mammalian counterpart to bacterial hsp 65 is both preferentially expressed in normal joints and subject to increased expression in arthritis of different aetiologies.

Manual para prevención y rehabilitación basada en la comunidad para personas ciegas y con otros impedimentos / Manual for prevention and rehabilitation based on the community for blind people and with other disabilities

Contiene: 1.Detección y evaluación: fichas. 2.Desarrollo psicomotor. 3.Ejercicios. 4.Actividades de la vida diaria. 5.Parálisis cerebral. 6.Poliomielitis. 7.Lesiones medulares. 8.Poliomielitis. 9.Lesiones medulares. 10.Parálisis braquial obstétrica. 11.Articulaciones dolorosas. 12.Retardo mental. 13.Ciegos. 14.Problemas en la comunicación. 15.Educación especial. 16.Ataques. 17.Lepra. 18.Ayudas biomecánicas. 19.Trabajo y las personas discapacitadas