Arthritis in Leprosy Without Specific Skin Lesion

Leprosy patients could display a great variability of signs and symptoms. An overabundance of rheumatic manifestations, occuring alone or in varying combinations, are associated with leprosy, particularly with lepra reactions A study involving seventy cases of leprosy found that rheumatic manifestations were seen in 61.42% of cases: arthritis in 54.28% and soft tissue rheumatism in 17.14%. Enthesitis was seen in 2.84% of cases. Rheumatic manifestations may be the primary complaint, thus delaying accurate diagnosis. Musculoskeletal involvement in leprosy is the third most frequent manifestation after dermatological and neurological involvements. It can occur at anytime during the infection. Articular inflammation in leprosy, which closely mimics other rheumatic disorders, usually occurs in reactive states, particularly erythema nodosum leprosum (ENL).1 About 1–5% of leprosy patients are reported of developing arthritis (synovial inflammation) at some stage of the disease but this rate increases to over 50% during lepra reactions.2 Here we report a case of arthritis in leprosywithout any typical skin lesion thus causing a delay in diagnosis

Avascular Necrosis of the Right Femoral Head in a Systemic Lupus Erythematosus Patient

According to the 1993 Association Research Circulation Osseous, idiopathic avascular necrosis of the femoral head is defined as the presence of disease or other causes that result in ischemic osteonecrosis of the femoral head without the presence of trauma or sepsis. Based on the above defi nition, idiopathic avascular necrosis(AVN) includes those that are the result of steroid administration, systemic lupus erythematosus, alcoholic consumption, etc. The pathogenesis of AVN is still obscure; however, it is basically caused by vascular circulation disorder, cell death and decreased capability of bone repair.1,2 Systemic lupus erythematosus (SLE) is characterized by the presence of systemic immune dysregulation, autoantibody formation, immune complex in the circulation, and activation of the systemic complement. The pathology during recurrence of SLE, among others, is the presenceof vascular lesion in the form of infl ammation, thrombosis, endothelial injury in which the three of them are predispositions for atherosclerosis. The vascular lesion will cause microcirculation damage which is a risk factor for the occurrence of AVN in activation of SLE. Besides being caused by vascular lesion during activation of SLE, AVN is also triggered by fat deposition in SLE patients as a result of long term steroid therapy that causes abnormal blood fat level.1,2 Patients with SLE who have undergone pharmacologic treatment with systemic steroid either in oral or injection form will have 10 to 40 times the risk of having idiopathic AVN. High dose of systemic steroid treatment of more than 4000 mg of prednisone administered for more than three months or low dose of oral steroid administered for seven days can become a risk factor for AVN. The mechanism of AVN caused by steroid treatmentis associated with hypercoagulation, fi brinolysis disorder, and thrombosis of the bone vein.1,2,3 We report a case of AVN of the right femoral head in an SLE patient

Erosive Osteoarthritis

Osteoarthritis (OA) is a degenerative joint disease characterized by the erosion of cartilage joints, hypertrophy of the marginal bone, subchondral sclerosis, and the morphological and biochemical changes of synovial membrane and joint capsule.This clinical syndrome is characterized by joint pain caused by degeneration of the joints. It is the most common joint disease to afflict the elderly and it occurs more often with age.1–3 Erosive osteoarthritis is a subset of OA in which there is a destruction of the joints as a result of inflammation.3,4 Changes mainly occur on the distal interphalangeal (DIP) joints, proximal interphalangeal (PIP) joints, carpometacarpal (CMC) joints, and very rarely occur on other joints of hand or of other body parts.3–5 The diagnosis is in accordance with the criteria of American College of Rheumatology (ACR) for OA and is supported by the existence of bone erosion on the radiological image. The management of this disease is merely for palliative purpose

Avascular Necrosis of the Right Femoral Head in Female Patient with Systemic Lupus Erythematosus

Avascular necrosis (also known as osteonecrosis, aseptic necrosis, or ischemic necrosis) represents collection of pathologic conditions from various etiologies causing impairment of blood supply to particular bone resulting in bone cellular death.Avascular necrosis remains a significant cause of morbidity in patients with systemic lupus erythematosus (SLE).1 It often involves multiple joints in SLE, in which the femoral head is involvedin most of these patients. Corticosteroids use is known as a major risk factor in the development of this complication.2-3 We report this case due to its quite common occurrence in SLE patients. The early recognition of avascular necrosis is essentialto prevent morbidit

Knee Arthritis in an HIV Positive Patient - Not Associated with Antiretroviral Therapy

Human immunodefi ciency virus (HIV)-associated arthritis is an oligoarthritis which predominantly affect the knees and ankles. It tends to be selflimited and to last less than six weeks. However, some patients with HIV-associated arthritis have been reported to have a disease course of more than six weeks with joint destruction. Synovial fl uid cultures are typically sterile and radiographs of the affected joints are usually normal except in those rare patients with a prolonged duration of symptoms in whom joint-space narrowing can occur.1,2 The pathophysiology of HIV specific arthritis types is not fully understood but drugs of the highly active antiretroviral therapy, in particular indinavir, are supposed to cause arthritis or rheumatological complaints.3 However,recently both human T-lymphotropic virus (HTLV) type I and HTLV-II have been suggested to induce infl ammatory or autoimmune reactions which can increase signifi cantly the incidence of arthritis.4 We report a patient with HIV infection presenting as knee arthritis which was apparently not associated with antiretroviral therapy

Management of Salmonella Septic Bursitis in Immunocompromised Host Post Renal Transplant

Salmonella as a causative agent in septic bursitis is considered rare. We report a case of 56 year old male with history of renal transplantation and using mycophenolate mofetil, cyclosporine and methylprednisolone as maintenance, admitted due to 3-week-fever associated with tenderness and swelling on left shoulder. Upon investigation, a diagnosis of septic bursitis was established. Salmonella enteritidis as the definitive causative agent was revealed. He was treated with meropenem 1g IV three times daily and levofloxacin 500 mg IV once a day for 3 weeks, followed by oral ciprofloxacin 500 mg twice a day for 2 weeks and oral metronidazole 500 mg three times a day for 1 week with a total duration of 5 weeks of antibiotics. On the subsequent follow up there was no recurrence episode of fever and the swelling of the left shoulder subsided, no tenderness noted and the patient has no limitation of range of movement. Since immunocompromised state complicates the management, the duration of therapy may twice longer than the typical management of septic bursitis. Salmonella as etiologic agent should be considered as differential in immunocompromised patient with septic bursitis

Risk of Cardiovascular Disease in Rheumatoid Arthritis Patients

Despite rheumatoid arthritis (RA) therapy development has been in advance level today, its mortality remains increasing in general population. The mortality is mainly caused by early-manifested atherosclerosis and other cardiovascular complications. Available evidences showthis condition appears in early stage of the disease. Thus, early detection and management of cardiovascular risk, followed by control of these factors are necessaryto reduce morbidity and mortality of RA patient