Neglected tropical rheumatic diseases.

The complexities of dealing with rheumatic diseases in tropical countries are diverse and likely due to limited health care infrastructure, lack of diagnostic and therapeutic facilities, impact of dominant prevailing diseases, and the challenges of differentiating from infectious and non-infectious disease mimics. Several tropical diseases present with musculoskeletal and rheumatic manifestations and often pose a diagnostic dilemma to rheumatologists. The diagnosis is often delayed or the disease is misdiagnosed, leading to poor patient outcomes. Endemic tropical diseases like tuberculosis and leprosy have myriad rheumatic presentations and remain important differentials to consider in patients with rheumatic manifestations. Infection with human immunodeficiency virus is a great masquerade and can mimic manifestations of multiple diseases. The role of viral infections in triggering and perpetuating autoimmunity is well known and chikungunya arthritis is a classic example of the same. This review highlights the rheumatic manifestations of tropical diseases and aims to create awareness among the caregivers. Key Points • It is crucial to be aware and identify infectious diseases presenting with rheumatic manifestations in the tropics. • Presentations akin to classic rheumatic syndromes such as rheumatoid arthritis, spondyloarthritis, systemic lupus erythematosus and vasculitis are common.

[Analysis of 29 cases of scleritis. Experience of a Rheumato-Ophthalmology Service]. / Análise de 29 casos de esclerite. Experiência de um serviço de Reumato-Oftalmologia.

UNLABELLED: Scleritis are entities that may have rheumatic diseases, infections or tumors as etiologic factors or may be a disease restricted only to the eye. PURPOSE: To share a three year experience of a rheumato-ophthalmologic ambulatory in the diagnosis and treatment of patients with scleritis. METHODS: This was a study of 29 cases. All of them were analyzed by the Ophthalmology and Rheumatology Services. RESULTS: From the 29 cases, an underlying disease was found in 55.17%. Rheumatic diseases were present in 34.4%; infectious in 20.6%. Idiophatic forms of scleritis did not differ from the rheumatic ones although a higher number of necrotizing cases were seen in the later group (with no statistical significance). Scleritis due to rheumatic diseases was treated more frequently with oral corticosteroids and immunosuppressive drugs. CONCLUSIONS: Patients with scleritis have a high rate of infectious and rheumatic diseases. Cooperation of rheumatologists and ophthalmologists was useful for the etiologic identification of patients with scleritis.

Análise de 29 casos de esclerite. Experiência de um serviço de Reumato-Oftalmologia / Analysis of 29 cases of scleritis. Experience of a Rheumato-Ophthalmology Service

Esclerites são doenças que podem ter como causa uma doença reumatológica, infecciosa ou tumoral ou, ainda, ser uma entidade restrita apenas ao olho. Objetivo: Relatar a experiência de dois anos de um ambulatório conjunto de Reumato-Oftalmologia no diagnóstico e acompanhamento de pacientes com esclerite por três anos. Métodos: Esta é uma análise de 29 casos de esclerite. Todos os casos foram avaliados pelo serviço de Oftalmologia e pelo de Reumatologia. Resultados: Dos 29 casos identificados, foi possível identificar uma doença subjacente em 55,17 por cento dos casos. Observamos doenças reumáticas em 34,4 por cento e infecciosas 20,6 por cento dos casos. As esclerites idiopáticas não se distinguiram das reumáticas quanto às características clínicas embora um maior número de casos com a forma necrosante tenha sido visto nas reumáticas (sem significância estatística). Esclerites com doença reumática subjacente foram tratadas mais vezes com corticóides orais e imunossupressores. Conclusões: A cooperação entre reumatologistas e oftalmologistas se mostrou útil na identificação etiológica de pacientes com esclerite.

Scleritis are entities that may have rheumatic diseases, infections or tumors as etiologic factors or may be a disease restricted only to the eye. Purpose: To share a three year experience of a rheumato-ophthalmologic ambulatory in the diagnosis and treatment of patients with scleritis. Methods: This was a study of 29 cases. All of them were analyzed by the Ophthalmology and Rheumatology Services. Results: From the 29 cases, an underlying disease was found in 55.17 percent. Rheumatic diseases were present in 34.4 percent; infectious in 20.6 percent. Idiophatic forms of scleritis did not differ from the rheumatic ones although a higher number of necrotizing cases were seen in the later group (with no statistical significance). Scleritis due to rheumatic diseases was treated more frequently with oral corticosteroids and immunosuppressive drugs. Conclusions: Patients with scleritis have a high rate of infectious and rheumatic diseases. Cooperation of rheumatologists and ophthalmologists was useful for the etiologic identification of patients with scleritis.

Enthesopathy in leprosy.

OBJECTIVE: To determine whether patients with leprosy have enthesopathy at the calcaneus of plantar fascia. METHODS: In a radiographic study of over 3 years, we investigated the presence and location of enthesophytes in patients with leprosy compared to healthy age and sex matched controls with no evidence of bone or joint disease. RESULTS: Calcaneus enthesopathy occurred significantly more frequently in patients with leprosy than in controls, but no difference in the location of enthesophytes was found between the 2 groups. Calcaneus spurs were detected more frequently in lepromatous patients than in tuberculoid patients. CONCLUSION: Enthesitis is a manifestation of leprosy and may be more common in lepromatous than in tuberculoid patients.

[Comparative ecology of tuberculosis and hanseniasis as they coincide endemically in tropical countries]. / Ecologia comparada da tuberculose e da hanseníase-tal como se cruzam, endêmicas, en terras tropicais.

The authors discuss the several aspects of the co-sensibilization in the infections produced by M. Tuberculosis and M. hanseniae. Attention is called to Rabello's pioneer works written in 1935 and the subsequent works written by several Argentinian and Brazilian authors. Special emphasis is made to the experimental works in animals by Azulay. The authors discuss the aspects of competitiveness, protection and the crossed granulomatosis answers to the infections.

[Acro-osteolysis in leprosy. Apropos of 19 personal cases]. / Acro-ostéolyses au cours de la lèpre. A propos de 19 observations personnelles.

Using their own personal series of 19 cases of leprosy complicated by massive osteolysis (AO), along with a comparison of these cases with data from previously published reports, the authors review the principal clinical and radiological findings of these manifestations which are not observed except in cases of leprosy where neuropathy is present, even though other factors (perforating plantar ulcers, poor hygiene, traumatisms) may play a contributing role independent of possible interference from non specific osteoarthritis or Hansen's bacilla, itself. After reviewing other causes of massive osteolysis and discussing the pathogeny of these manifestations during leprosy, the authors refer to the various therapies which can prevent or stabilize osteolysis or aid the patient to better tolerate its manifestations.

Acro-ostéolyses au cours de la lèpre. A propos de 19 observations personnelles

Using their own personal series of 19 cases of leprosy complicated by massive osteolysis (AO), along with a comparison of these cases with data from previously published reports, the authors review the principal clinical and radiological findings of these manifestations which are not observed except in cases of leprosy where neuropathy is present, even though other factors (perforating plantar ulcers, poor hygiene, traumatisms) may play a contributing role independent of possible interference from non specific osteoarthritis or Hansen's bacilla, itself. After reviewing other causes of massive osteolysis and discussing the pathogeny of these manifestations during leprosy, the authors refer to the various therapies which can prevent or stabilize osteolysis or aid the patient to better tolerate its manifestations