Abstract
Twenty-one patients with Virchowian hanseniasis from the Hospital Lauro de Souza Lima (Bauru-SP), were clinically studied in order to establish the type of arthritis that occurs in erythema nodosum hansenicum (ENH). For this form of joint involvement in hanseniasis, the authors suggest the name "reactional arthritis". Patients with evidence of other rheumatic diseases were not included in their investigation. Reactional arthritis may preceed, accompany or follow the appearance of ENH or polymorphous lesions, but in approximately half of the cases studied they were absent. Arthritis generally has an acute beginning and may be mono-articular, oligoarticular or polyarticular, symmetrical or asymmetrical. Relapses of articular manifestations occur frequently. Arthralgia, constitutional symptoms, hepatomegaly, generalized painful lymph-node enlargement, peripheral neuritis and other clinical manifestations were observed. The laboratory and radiological findings, however, were not specific. During the period of this study. (maximum — 30 months), relapses of articular manifestations were common, with a tendency for the ENH lesions to become more discrete or no longer present. In no case did the articular manifestations continue or did they provoke sequels. The paper discusses the differential diagnosis of reactional arthritis with gout, traumatic arthritis, septic arthritis, osteomyelitis, osteoarthritis, sickle-cell anemia, rheumatic fever, and diffuse connective tissue diseases. It emphasizes that in any study of articular involvement in Hanseniasis, the possibility of its association with other rheumatic diseases should be excluded. On the other hand, reactional arthritis should be considered in the differential diagnosis of rheumatic diseases.
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