Lest we forget Hansen's disease (leprosy): an unusual presentation with an acute onset of inflammatory polyarthritis and the rheumatology experience.

Several forms of arthritis and rheumatism can sometimes complicate leprosy. However, its presentation as an acute onset arthritis is unusual. We report two adult male naïve patients who presented to our rheumatology outpatient clinic with acute onset inflammatory polyarthritis, skin rash and mild sensory neurodeficit. Borderline lepromatous leprosy (in type I lepra reaction) was diagnosed. We also refer to 19 case records of Hansen arthritis in the clinic database (1998-2007) from approximately 35,000 patients and a community study to highlight the missed diagnosis of Hansen's disease and its unusual association with rheumatoid arthritis. In countries like India where leprosy is endemic, this disease also merits attention in rheumatology clinics.

Classification of human population based on HLA gene polymorphism and the concept of Prakriti in Ayurveda.

BACKGROUND: Correlating phenotypes with genotypes remains the major postgenomic challenge. Attempts to correlate phenotype characteristics associated with ethnicity, geographical divisions, or diseases to genotypes have had limited success. This means that current approaches for identifying phenotypes associated with haplotypes may be inadequate. OBJECTIVES: We hypothesize that a human phenome based on Ayurveda could provide an appropriate approach. Specifically, there could be a genetic basis for the three major constitutions (Prakriti) described in Ayurveda. The Prakriti classification is based on differences in physical, physiological, and psychologics characteristics and is independent of racial, ethnic, or geographical considerations. It may provide an appropriate means of classifying phenotypes to be considered collectively for genotyping. DESIGN: As a pilot study to test the hypothesis, we evaluated 76 subjects both for their Prakriti and human leucocyte antigen (HLA) DRB1 types. The genomic DNA was extracted using a standard protocol. Subsequently, HLA DRB1 typing was done by low-resolution polymerase chain reaction sequence specific primers and oligonucleotide probes. RESULTS: We observed a reasonable correlation between HLA type and Prakriti type. The complete absence of the HLA DRB1*02 allele in the Vata type and of HLA DRB1*13 in the Kapha type are significant, with X2 = 4.715 and p < 0.05. HLA DRB1*10 had higher allele frequency in the Kapha type than in the Pitta and Vata types. CONCLUSION: Ayurveda classifies the whole human population in three major constitutions as Vata, Pitta, Kapha and their possible combinations. Their homologous relation to human genetic structure needs to be studied for validation. If validated, our hypothesis would have far reaching implications for pharmacogenomics, modern genetics, human health, and Ayurveda.