Chronic Polyarthritis Mimicking Rheumatoid Arthritis in a Patient with Leprosy

Currently leprosy is now still a global threat in the world even after the introduction of multidrug therapy (MDT), including in Indonesia.1 World Health Organization (WHO) data revealed that in 2002 there were 597,000 cases worldwide and the prevalence is only less than 1 every 10,000 populations.2 Nevertheless, the latest data showedthat 83% of leprosy cases concentrated in only 6 countries: Indonesia, India, Brazil, Madagascar, Myanmar, and Nepal.3 The most common manifestations of leprosyare cutaneous and neuritic manifestation. Rheumatologic manifestation is another common manifestation of leprosy.4-7 Prevalence of rheumatologic manifestation of leprosy is range from 1% to 77% of all leprosy patients.4-11 Study conducted by Mandal et al in India revealed that the prevalence of rheumatologic manifestation was 5.9%, in Brazil,6 another study by Pereira revealed the prevalence of 9.1%.5 Hadi, in Indonesia,showed the prevalence of arthritic manifestation was 7.5%.8 Rheumatologic manifestations that can be found in leprosy are polyarthritis or oligoarthritis, soft tissue rheumatism, noninflammatory arthritis, and also enthesitis.4-7 We report a patient presenting with polyarthritis as the primary manifestation of leprosy

Erosive Polyarthritis in Multicentric Reticulohistiocytosis Mimics Rheumatoid Arthritis

Multicentric reticulohistiocytosis (MRH) is a very rare multisystemic syndrome.1,2 The first case of MRH was described by Goltz and Layman in 1954 and so far only less than 200 cases have been reported.3-5 It is characterized by the insidious onset of polyarthritis that often evolves into a severe erosive deforming arthritis and characteristic skin lesions composed of nodules and plaques containing lipid-laden (periodic acidSchiff-positive) histiocytes and multinucleated giant cells.6 It most commonly affects the handsand cervical spine.7 MRH is also known as lipoid dermatoarthritis, lipoid rheumatism, and giant cell reticulohistiocytosis.4 MRH is occured due to infiltration of multinucleated giant cells and histiocytes into various tissues. The typical pictures include skin nodules and destructive polyarthritis.3 This entity is frequently mistaken for rheumatoid arthritis (RA).3 MRH is often associated with systemic complication and various types ofmalignancy. Therefore, sometimes it is considered a paraneoplastic syndrom

Correlation Between Anti-cyclic Citrullinated Peptide Antibodies and the Severity of Clinical Manifestation, Laboratory Manifestation, and Radiological Joint Destruction in Rheumatoid Arthritis Patients

Background. The second generation anti-cyclic citrullinated peptide test (CCP2) displays sensitivity comparable to that of rheumatoid factor (RF) (approximately 80%) but with superior specificity (98%) . Several observations have indicated that early rheumatoid arthritis (RA) patients with positive anti-CCP may develop a more erosive disease than those without anti-CCP.Objective. The purpose of this cross-sectional study was to investigate the correlation between anti-CCP antibodies and clinical and laboratory parameters and radiological joint destruction in RA patients.Methods. We studied 31 patients with RA fulfilling the 1987 revised criteria of American College of Rheumatology in Rheumatology Clinic of Saiful Anwar General Hospital, Malang, Indonesia. Clinical parameters were collected such as age, sex, visual analog scale,disease duration and diseases activity score (DAS28-3(CRP)). Laboratory parameters were WBC, hemoglobin, platelet count, erythrocyte sedimentation rate, and Creactive protein. Analyzed autoantibody profiles were RF and anti-CCP (ELISA methode). Radiological jointdestruction was evaluated from bilateral postero-anterior manus x ray (Sharp score).Results. Anti-CCP antibodies were detected in 48.4% of RA patients with mean antibody concentration was 291.24±143.67 (range 16-523.8) units. Anti CCP level was significantly correlated with duration of RA (month) (p=0.04, r=0.371), RF level (p=0.002, r=0.542) andSharp score (p=0.048, r=0.358), but was not significantly correlated with other clinical and laboratory parameters.Conclusion. Anti-CCP level was correlated with duration of disease, RF, and Sharp score