Cossermelli-Messina W, Festa Neto C, Cossermelli W
Rheumatology Division, School of Medicine, University of São Paulo, Brazil.
J Rheumatol. 1998 Jan;25(1):111-9.
To study the articular inflammatory manifestations of leprosy.
Sixty patients with leprosy from a public clinic in São Paulo, Brazil, participated in a study regarding their articular manifestations. The diagnosis and classification of leprosy were established by the clinical picture, skin smears, skin biopsy, and delayed hypersensitivity test to Mycobacterium leprae antigens (Mitsuda test). According to the Madrid and Ridley-Jopling classifications, 46 patients had lepromatous leprosy, 7 had borderline leprosy, 4 had tuberculoid leprosy, and 3 had indeterminate leprosy. History, general and articular examinations, and roentgenograms were employed and complemented in several cases by scintigraphic examinations with technetium methylene diphosphonate and computed tomographic studies.
Three patients were excluded from study due to an association with a rheumatic disease. Among the 57 remaining patients, 44 had peripheral arthritis characterized by involvement of small joints (23/44), large joints (4/44), or both (17/44). The mean duration of arthritis was 11 years (range 1 mo to 51 yrs). Arthritis was detected in all subtypes of patients with leprosy. Supplementary radiological evaluation established the extent of inflammation and diagnosis of sacroiliitis. The diagnosis of sacroiliitis, based on the presence of sclerosis, erosions, and narrowing of the cartilage space in the sacroiliac joints, was established in 35 of 55 radiographs. Sacroiliitis varied from grade I to III, according to the Bennet and Wood classification, and was bilateral in most cases (30/35). There was no significant correlation between low back pain and the finding of sacroiliitis.
Articular inflammatory manifestations may exist in patients with different forms of leprosy, and can follow a chronic course. In addition, sacroiliitis is a common, previously unrecognized manifestation in patients with leprosy.
研究麻风病的关节炎症表现。
来自巴西圣保罗一家公共诊所的60例麻风病患者参与了一项关于其关节表现的研究。麻风病的诊断和分类依据临床表现、皮肤涂片、皮肤活检以及对麻风杆菌抗原的迟发型超敏反应试验（光田试验）来确定。根据马德里分类法和里德利 - 乔普林分类法，46例患者为瘤型麻风，7例为界线类麻风，4例为结核样型麻风，3例为未定类麻风。采用病史采集、全身及关节检查以及X线片检查，部分病例还补充了亚甲基二膦酸盐锝骨闪烁显像检查和计算机断层扫描研究。
3例因合并风湿性疾病被排除在研究之外。在其余57例患者中，44例有外周关节炎，其特征为小关节受累（23/44）、大关节受累（4/44）或大小关节均受累（17/44）。关节炎的平均病程为11年（范围1个月至51年）。所有麻风病亚型患者中均检测到关节炎。补充的放射学评估确定了炎症程度并诊断出骶髂关节炎。根据骶髂关节中硬化、侵蚀以及软骨间隙变窄的情况，在55张X线片中诊断出35例骶髂关节炎。根据贝内特和伍德分类法，骶髂关节炎从I级到III级不等，大多数病例为双侧受累（30/35）。下背痛与骶髂关节炎的发现之间无显著相关性。
不同类型的麻风病患者可能存在关节炎症表现，且可呈慢性病程。此外，骶髂关节炎是麻风病患者中一种常见但此前未被认识到的表现。
