Feitosa Maria Stella Cochrane, Santos Gabriela Profírio Jardim, Cerqueira Selma Regina Penha Silva, Rodrigues Gabriel Lima, da Mota Licia Maria Henrique, Gomes Ciro Martins
Programa de Pós-Graduação em Medicina Tropical, Faculdade de Medicina, Universidade de Brasília, Brasilia, Brazil.
Programa de Pós-Graduação em Ciências Médicas, Faculdade de Medicina, Universidade de Brasília, Brasilia, Brazil.
Front Med (Lausanne). 2022 Apr 25;9:870584. doi: 10.3389/fmed.2022.870584. eCollection 2022.
Leprosy causes significant pain in affected patients, especially those experiencing reactional states. Fibromyalgia is characterized by widespread pain and is often accompanied by fatigue. Confusion between the clinical manifestations of fibromyalgia and those of leprosy reactions is possible at the primary care level, the first contact with the health system in most cases. We aimed to determine whether the presence of leprosy reactional states is related to the development of signs and symptoms included in the case definition of fibromyalgia and establish recommendations for obtaining the correct diagnosis. We performed a cross-sectional study in which the main independent variable was the presence of any leprosy reactional state and the primary dependent variable was the diagnosis of fibromyalgia according to the 2016 Revisions of the 2010/2011Fibromyalgia Provisional Criteria of the American College of Rheumatology. Forty-three patients were included in the study. Twenty-eight (65.12%) patients had a type I reactional state, only 1 (2.33%) had an isolated type II reactional state, and 5 (11.63%) had both type I and type II reactional states. Only 2 patients who suffered from cooccurring type I and II reactional states obtained sufficient scores for the diagnosis of fibromyalgia. Although diffuse pain was common in leprosy patients, none of the types of reactional states were associated with a higher frequency of criteria for fibromyalgia. We can conclude that a leprosy reactional state is probably not a risk factor for fibromyalgia but can act as a confounder, as tender points may be similar in both diagnoses. In patients diagnosed with fibromyalgia, leprosy must be considered in the differential diagnosis in endemic regions.
麻风病会给受影响的患者带来巨大痛苦，尤其是那些处于反应状态的患者。纤维肌痛的特征是广泛疼痛，常伴有疲劳。在初级保健层面，即在大多数情况下患者与卫生系统的首次接触中，纤维肌痛和麻风病反应的临床表现可能会混淆。我们旨在确定麻风病反应状态的存在是否与纤维肌痛病例定义中所包含的体征和症状的发展相关，并制定获得正确诊断的建议。我们进行了一项横断面研究，其中主要的自变量是任何麻风病反应状态的存在，主要因变量是根据美国风湿病学会2010/2011年纤维肌痛临时标准2016年修订版诊断的纤维肌痛。该研究纳入了43名患者。28名（65.12%）患者有I型反应状态，只有1名（2.33%）有孤立的II型反应状态，5名（11.63%）同时有I型和II型反应状态。只有2名同时患有I型和II型反应状态的患者获得了足以诊断纤维肌痛的分数。尽管弥漫性疼痛在麻风病患者中很常见，但没有一种反应状态与纤维肌痛标准的更高频率相关。我们可以得出结论，麻风病反应状态可能不是纤维肌痛的危险因素，但可能会成为一个混淆因素，因为两种诊断中的压痛点可能相似。在诊断为纤维肌痛的患者中，在流行地区的鉴别诊断中必须考虑麻风病。
