title: Leprosy in a rheumatology setting: a challenging mimic to expose.
abstract: Leprosy can manifest arthritis both as a complication and a comorbid disorder and can be a challenging differential diagnosis in rheumatology practice due to several common features. Uncommonly, it may present as acute severe polyarthritis with skin lesions and neurological deficit or a digital vasculitis and gangrene. We demonstrate this profile in a retrospective case series analysis of 33 patients (13 females, median age 55 years) in a community-based clinic setting over the period 1998-2012; an electronic search of case records of 41,000 patients was carried out. Rheumatoid arthritis (RA) coexisted in seven patients (three lepromatous, two tuberculoid, and two polyneuritic). Serological rheumatoid factor and antinuclear antibody were often false positive. Several patients of RA were on long-term supervised methotrexate. Rheumatologists should be aware of this clinical mimic to avoid errors in diagnosis and management.
authors: Department of Physiology, Bharati Vidyapeeth Medical College, NIBM Road, 10 Memory Garden, Kondhwa, Pune, 411048, India, shslvi@gmail.com.
authors: Sheetal
authors: S
authors: Salvi
authors: Arvind
authors: A
authors: Chopra
mesh_terms: D000328:Adult; D000368:Aged; D000974:Antibodies, Antinuclear / Q000097:blood; D018501:Antirheumatic Agents / Q000627:therapeutic use; D001168:Arthritis / Q000150:complications / Q000175:diagnosis; D001172:Arthritis, Rheumatoid / Q000150:complications / Q000175:diagnosis; D003937:Diagnosis, Differential; D003951:Diagnostic Errors; D005189:False Positive Reactions; D005260:Female; D006801:Humans; D007918:Leprosy / Q000150:complications / Q000175:diagnosis*; D008297:Male; D008727:Methotrexate / Q000627:therapeutic use; D008875:Middle Aged; D012189:Retrospective Studies; D012217:Rheumatoid Factor / Q000097:blood; D012219:Rheumatology / Q000379:methods*; D063189:Symptom Assessment
chemical_list: D000974:Antibodies, Antinuclear; D018501:Antirheumatic Agents; D012217:Rheumatoid Factor; D008727:Methotrexate
references: QJM. 2007 Apr;100(4):193-201
references: 17434910
references: Indian J Lepr. 1985 Apr-Jun;57(2):350-3
references: 4078361
references: Lepr Rev. 2010 Mar;81(1):59-68
references: 20496570
references: Clin Immunol Immunopathol. 1983 Dec;29(3):359-68
references: 6416726
references: Int J Rheum Dis. 2009 Apr;12(1):64-9
references: 20374320
references: Rheumatology (Oxford). 2007 Apr;46(4):653-6
references: 17077158
references: J Rheumatol. 2009 Mar;36(3):614-22
references: 19208598
references: Rheumatology (Oxford). 2010 Dec;49(12):2237-42
references: 20724432
references: Curr Rheumatol Rep. 2010 Dec;12(6):414-9
references: 20842467
references: Semin Arthritis Rheum. 1985 May;14(4):280-6
references: 3909408
references: J Rheumatol. 1998 Jan;25(1):111-9
references: 9458213