Hansen’s Disease and Rheumatoid Arthritis Crossover of Clinical Symptoms: A Case Series of 18 Patients in the United States

Sarah M. Labuda Tulane University School of Medicine, New Orleans, Louisiana;

Search for other papers by Sarah M. Labuda in
Current site
Google Scholar
PubMed
Close
,
John S. Schieffelin Tulane University School of Medicine, New Orleans, Louisiana;

Search for other papers by John S. Schieffelin in
Current site
Google Scholar
PubMed
Close
,
Jeffrey G. Shaffer Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana;

Search for other papers by Jeffrey G. Shaffer in
Current site
Google Scholar
PubMed
Close
, and
Barbara M. Stryjewska National Hansen’s Disease Program, Baton Rouge, Louisiana

Search for other papers by Barbara M. Stryjewska in
Current site
Google Scholar
PubMed
Close
Restricted access

Hansen’s Disease (HD) is a rare, chronic granulomatous infection of the skin and peripheral nerves caused by the noncultivable organism Mycobacterium leprae. Arthritis is the third most common symptom of HD. Subjects with both confirmed HD on skin biopsy and chronic arthritis were identified at the National Hansen’s Disease Program (NHDP). We conducted a series of medical chart reviews and extracted and logged personally deidentified data into a database and carried out descriptive analyses. Eighteen of 261 subjects presented to the NDHP with both HD and chronic arthritis between 2001 and 2015. Among these, 16 were male, 16 were white, and 15 were residents of Louisiana. The median age at diagnosis of HD was 67 years. Ten of these subjects were diagnosed with borderline lepromatous leprosy, seven were diagnosed with lepromatous, and one was diagnosed with borderline tuberculoid leprosy. Patients were symptomatic with arthritis for a median of 5.3 years before HD diagnosis. Sixty-two percent of patients (11) were diagnosed with rheumatoid arthritis (RA) before HD diagnosis, and 10 of which were seronegative RA. Hands, feet, wrists, and elbows were most commonly reported as affected joints. Over half of the patients (61%) had completed HD multidrug therapy at the time of review, and 73% of these subjects had persistent joint pain requiring steroids or methotrexate for symptomatic control. Chronic arthritis in HD patients is present in a series of US-acquired cases of HD. Arthritis did not resolve with successful treatment of HD in most cases.

    • Supplemental Materials (PDF 396 KB)

Author Notes

Address correspondence to Sarah M. Labuda, Tulane University School of Medicine, 1440 Canal Street, Suite 1600, New Orleans, LA 70112-2632. E-mail: slabuda@tulane.edu

Financial support: J. S. S. received financial support from NIH grant 5K12HD043451.

Authors’ addresses: Sarah M. Labuda and John S. Schieffelin, Tulane University School of Medicine, New Orleans, LA, E-mails: slabuda@tulane.edu and jschieff@tulane.edu. Jeffrey G. Shaffer, Department of Global Biostatistics and Data Science, New Orleans, LA, E-mail: jshaffer@tulane.edu. Barbara M. Stryjewska, National Hansen’s Disease Program, Baton Rouge, LA, E-mail: bstryjewska@hrsa.gov.

  • 1.

    Nolen L et al. 2014. Incidence of Hansen’s disease—United States, 1994–2011. MMWR Morb Mortal Wkly Rep 63: 969972.

  • 2.

    Truman RW et al. 2011. Probable zoonotic leprosy in the southern United States. N Engl J Med 364: 16261633.

  • 3.

    Ridley DS, Jopling WH, 1966. Classification of leprosy according to immunity. A five-group system. Int J Lepr Other Mycobact Dis 34: 255273.

  • 4.

    World Health Organization, 1998. WHO Model Prescribing Information: Drugs Used in Leprosy. Geneva, Switzerland: WHO.

    • PubMed
    • Export Citation
  • 5.

    Aletaha D et al. 2010. 2010 rheumatoid arthritis classification criteria: an American college of rheumatology/European league against rheumatism collaborative initiative. Arthritis Rheum 62: 25692581.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 6.

    Ribeiro SL, Pereira HL, Silva NP, Neves RM, Sato EI. 2008. Anti-cyclic citrullinated peptide antibodies and rheumatoid factor in leprosy patients with articular involvement. Braz J Med Biol Res 41: 10051010.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 7.

    Zavala-Cerna MG et al. 2012. Anti-cyclic citrullinated peptide antibodies and rheumatoid factor sera titers in leprosy patients from Mexico. Rheumatol Int 32: 35313536.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 8.

    Guedes-Barbosa LS, Mangueira C, Scheinberg M, 2008. Anticitrulline peptide antibodies (CCP3) in leprosy sera: a negative association. Clin Rheumatol 27: 515516.

  • 9.

    Henriques CC, Lopez B, Mestre T, Grima B, Panarra A, Riso N, 2012. Leprosy and rheumatoid arthritis: consequence or association? BMJ Case Reports published online 13 August 2012.

    • PubMed
    • Export Citation
  • 10.

    Scollard DM, Joyce MP, Gillis TP, 2006. Development of leprosy and type 1 leprosy reactions after treatment with infliximab: a report of 2 cases. Clin Infect Dis 43: e19e22.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 11.

    Sobanko JF, Freeman AF, Palmore TN, Mendoza D, Richard Lee CC, Cowen EW, 2009. A Sri Lankan woman with rheumatoid arthritis and anesthetic plaques. J Am Acad Dermatol 60: 10181021.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 12.

    Lluch P et al. 2012. Development of leprosy in a patient with rheumatoid arthritis during treatment with etanercept: a case report. Semin Arthritis Rheum 42: 127130.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 13.

    Freitas DS, Machado N, Andrigueti FV, Reis Neto ET, Pinheiro MM, 2010. Hanseníase virchowiana associada ao uso de inibidor do fator de necrose tumoral: relato de caso. Rev Bras Reumatol 50: 333339.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 14.

    Lydakis C et al. 2012. Development of lepromatous leprosy following etanercept treatment for arthritis. Clin Rheumatol 31: 395398.

  • 15.

    Antônio JR, Soubhia RMC, Paschoal VDA, Amarante CF, Travolo ARF, 2013. Biological agents: investigation into leprosy and other infectious diseases before indication. An Bras Dermatol 88 (Suppl 1): 2325.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 16.

    Yens DA, Asters DJ, Teitel A, 2003. Subcutaneous nodules and joint deformity in leprosy: case report and review. J Clin Rheumatol 9: 181186.

  • 17.

    Salvi S, Chopra A, 2013. Leprosy in a rheumatology setting: a challenging mimic to expose. Clin Rheumatol 32: 15571563.

  • 18.

    U.S. Department of Health and Human, 2011. A Summary of Hansen’s Disease in the United States-2004–2013.131.

    • PubMed
    • Export Citation
  • 19.

    Pereira HLA, Ribeiro SLE, Sato SE. 2008. Manifestaões Reumáticas da Hanseníane. ACTA Reum Port 33: 407414.

  • 20.

    Rath D, Bhargava S, Kundu BK, 2014. Leprosy mimicking common rheumatologic entities: a trial for the clinician in the era of biologics. Case Rep Rheumatol 2014: 15.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 21.

    de Oliveira Fernandes RTM, Korinfskin JP, Espíndola MMM, de Oliveira Corrêa LM, 2014. Arthritis and diagnosis of leprosy: a case report and review of the literature. An Bras Dermatol 89: 323325.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 22.

    Sheetal S, Arvind C, 2009. Lest we forget Hansen’s disease (leprosy): an unusual presentation with an acute onset of inflammatory polyarthritis and the rheumatology experience. Int J Rheum Dis 12: 6469.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 23.

    Simeoni S et al. 2011. Leprosy initially misdiagnosed as sarcoidosis, adult-onset still disease, or autoinflammatory disease. JCR J Clin Rheumatol 17: 432435.

  • 24.

    Miladi MI, Feki I, Bahloul Z, Jlidi R, Mhiri C, 2006. Chronic inflammatory joint disease revealing borderline leprosy. Joint Bone Spine 73: 314317.

  • 25.

    Prasad S et al. 2013. Leprosy revealed in a rheumatology clinic: a case series. Int J Rheum Dis 16: 129133.

  • 26.

    Vengadakrishnan K, Saraswat PK, Mathur PC, 2004. A study of rheumatological manifestations of leprosy. Indian J Dermatol Venereol Leprol 70: 7678.

  • 27.

    Kaur MR, Grindulis K, Maheshwari M, Ellis CJ, Bhat J, Tan CY, 2007. Delayed diagnosis of leprosy due to presentation with a rheumatoid-like polyarthropathy. Clin Exp Dermatol 32: 784785.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 28.

    Han XY et al. 2008. A new Mycobacterium species causing diffuse lepromatous leprosy. Am J Clin Pathol 130: 856864.

  • 29.

    Han XY, Zhang J, Li L, 2015. Leprosy agents Mycobacterium lepromatosis and Mycobacterium leprae in Mexico: a clarification. J Clin Microbiol 53: 33873388.

  • 30.

    Han XY, Sizer KC, Velarde-Felix JS, Frias-Castro LO, Vargas-Ocampo F, 2012. The leprosy agents Mycobacterium lepromatosis and Mycobacterium leprae in Mexico. Int J Dermatol 51: 952959.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 31.

    Garrido-Mesa N, Zarzuelo A, Gálvez J, 2013. Minocycline: far beyond an antibiotic. Br J Pharmacol 169: 337352.

Past two years Past Year Past 30 Days
Abstract Views 106 106 11
Full Text Views 511 21 0
PDF Downloads 135 21 0
 
Membership Banner
 
 
 
Affiliate Membership Banner
 
 
Research for Health Information Banner
 
 
CLOCKSS
 
 
 
Society Publishers Coalition Banner
Save