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Bacterial infections: the arthritis of leprosy
1Guy's Hospital, London, UK.
Abstract:
Arthritis is a common feature of leprosy and contributes to disability. Direct invasion of joints and bones by mycobacteria may lead to a destructive arthritis in lepromatous disease. The infective process may involve few or many joints. Reactional states may occur spontaneously but usually after the initiation of anti-mycobacterial treatment. In both the type 1 reaction of borderline case and the type 2 reaction of the lepromatous disease, intense inflammation may occur at sites of infection. The immunology of the reactions is different but they share clinical features including a polyarthritis which may resemble rheumatoid disease. The joint disease may be chronic or relapsing, affecting the wrists and small joints of the hands in particular. Radiological erosions may occur. Mycobacterium leprae is not found in the synovium in this pattern of arthritis. Further study of this phenomenon might yield useful information above the mechanism of joint inflammation in other rheumatic diseases.
Insights
Arthritis is a common leprosy complication causing disability. While Mycobacterium leprae causes destructive joint issues, it
Area of Science:
- Rheumatology
- Infectious Diseases
- Immunology
Background:
- Arthritis is a frequent and disabling manifestation of leprosy.
- Mycobacterial invasion can cause destructive arthritis, particularly in lepromatous leprosy.
- Reactional states, common in leprosy, involve intense inflammation and polyarthritis.
Purpose of the Study:
- To explore the relationship between leprosy and arthritis.
- To understand the mechanisms of joint inflammation in leprosy.
- To investigate the clinical and immunological features of leprosy-associated arthritis.
Main Methods:
- Clinical observation of patients with leprosy-induced arthritis.
- Review of immunological responses during leprosy reactional states.
- Radiological assessment of joint damage.
Main Results:
- Leprosy can lead to chronic or relapsing polyarthritis, often affecting the wrists and hands.
- Reactional states (Type 1 and Type 2) present with polyarthritis mimicking rheumatoid disease.
- Radiological erosions may be present, but Mycobacterium leprae is not found in the synovium.
Conclusions:
- Leprosy-associated arthritis shares clinical features with rheumatoid disease.
- The synovium is not directly infected by Mycobacterium leprae in this arthritis pattern.
- Further research into this phenomenon may illuminate mechanisms of other rheumatic diseases.