Abstract

Leprosy (Hansen's disease) is caused by Mycobacterium leprae,through respiratory root and affects skin and nerves predominantly. This nerve injury can induce a lack of pain sensitivity, motor dysfunction and can ultimately lead to limb loss. Neuropathy causes post-traumatic septic arthritis and neuropathic joints. Acute and chronic joint involvement as  symmetric polyarthritis mimicking rheumatoid arthritis (RA) with or without lepra reaction has been reported. Leprosy appears in rheumatology as primary arthritis, a concomitant infection, or a treatment outcome. Joint pain and arthritis occur during reactive inflammation. Hansen's disease may also cause rheumatoid-like erosive deforming arthritis in large and small joints.
A descriptive cross-sectional study was undertaken in the Department of Dermatology and Venereology. The study included all leprosy cases but excluded patients with other types of arthritis. Patients with coagulopathy, connective tissue disorders, and collagen vascular disorders were excluded.
The mean age of 100 study participants was 41.30 years (SD - 19.23 years), 76% were male, 24% female. Most study participants had ulcers on their feet. 24 had left foot ulcers and 17 on the right. Lesions were also present on medial malleolus, hand, lower limbs, etc. 56% had no leprosy reaction, 24% type 2, and 20% type 1. Polyarthritis was the most prevalent rheumatological manifestation (34%), followed by tenosynovitis (32%). Some patients had enthesitis (16%), oligoarthritis (15%), dactylitis (12%), etc. Most lepromatous and tuberculoid leprosy patients had increased ESR and CRP.
Borderline and lepromatous leprosy often causes symmetrical polyarthritis, oligoarthritis, enthesitis, and dactylitis. Leprosy is rare in outpatient rheumatology, but rheumatologists must know this crucial differential diagnosis. Dermatologists should be involved when anti lepromatous medications to prevent unnecessary antirheumatic therapy.