Arthritis in Leprosy

Sandeep Chauhan; Anupam Wakhlu; Vikas Agarwal

Disclosures

Rheumatology. 2010;49(12):2237-2242. 

In This Article

Abstract and Introduction

Abstract

Leprosy, a chronic granulomatous infection caused by Mycobacterium leprae, classically presents with cutaneous and neurological manifestations. Musculoskeletal involvement though third most common is underdiagnosed and underreported. It may manifest in the form of Charcot's arthropathy, acute symmetrical polyarthritis or swollen hands and feet syndrome during lepra reactions, insidious-onset chronic symmetrical polyarthritis mimicking RA or as isolated tenosynovitis or tenosynovitis associated with arthritis or neuropathy. At times, articular involvement may be the sole presenting manifestation even without cutaneous lesions. Other rheumatological manifestations occasionally reported are enthesitis, sacroiliitis, cryoglobulinaemic vasculitis and DM. With increasing travel of population between tropical and temperate zones, it is likely that rheumatology clinics in countries free of leprosy may come across cases of leprosy with rheumatological manifestations. Delay in diagnosis and management may be detrimental and may result in deformities and loss of function. Not only this, but recent reports of leprosy being diagnosed in native white populations following anti-TNF-α therapy should alert rheumatologists across the globe to be more familiar with this disease. This review is aimed at presenting a comprehensive clinical scenario of various rheumatological manifestations of leprosy to sensitize rheumatologists and physicians across the continents.

Introduction

In this era of increased travel and migration, especially of people from the developing world to the developed world, there is need to understand those diseases that were hitherto confined to the developing world or tropical countries.[1] Leprosy is one such disease. Recently, a few cases of leprosy have been reported among native white Americans after treatment with infliximab or adalimumab.[2,3] Since anti-TNF-α mAbs are increasingly being used for the management of various rheumatological conditions, these cases highlight the importance of awareness of leprosy and its various presentations even in the geographical regions believed to be free of this disease.

Leprosy has been recognized for millennia and it develops insidiously over months and years. The word leprosy is derived from the ancient Greek word léprā, which means 'a disease which makes the skin scaly'. Leprosy is a chronic granulomatous infectious disease caused by Mycobacterium leprae. The causative agent M. leprae was first reported by G. H. Armauer Hansen in Norway in 1873.[4] Its mode of transmission is still uncertain and despite advances in diagnosis and treatment, it is a major cause of morbidity in many developing countries even today. The first mention of leprosy dates back to the 6th century BC in a medical treatise, Sushruta Samhita, by the surgeon Sushruta who flourished in India at that time. It later spread to Europe with the armies of Alexander the Great. Norway and Iceland were the most affected countries in the 17th century.

Its clinical manifestations are primarily confined to skin and peripheral nerves. However, musculoskeletal involvement including inflammatory arthritis, though underreported, is quite common. Rheumatologists should be aware of this disease since joint involvement occurs in ~75% of cases of leprosy and at times, is the only presenting manifestation.

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