Harrn Rheumatology 4Th Year Full Course Of

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These cases will teach students and junior doctors patients history, examination and initial investigations, with clinical photographs.Each case is followed by questions on the diagnosis and management.This book provides illustrated a succinct summary and providing an essential revision aid as well as a practical guide for students.

It made juniors doctors to make clinical decisions and choosing the best course of action in a specific condition.

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Atkin et al. 9 were the rst to describe such presentations in the absence of Lepra reaction.

The rst description of the disease dates back to the 6th century BC by Indian surgeon Sus- hruta.

The invasion of Asia by the armies of Alexander the Great saw the spread of the disease across Europe.

Leprosy now remains endemic predominantly in the developing world, with pockets of high prevalence identied in Brazil, Indonesia and India (South-east Asia SEA).

Together, these three countries account for 80 of all newly registered cases.

Although the num- ber of new cases detected globally has been on the declining trend, it remains a major problem in some of developing countries.

Improved connectivity across the continents has led to increasing global travel, and case reports of this disease amongst the migrants have sur- faced in developed nations as well.

The use of newer immunosuppressants, anti-tumor necrosis factor in par- ticular, have also been associated with reports of leprosy.

Harrn Rheumatology 4Th Year Full Course Of

Early diagnosis and full course of treatment are critical for prevention of lifelong neuropathy and disability in these cases.

The prevalence of rheumatic manifestations in leprosy varies across case series, ranging from 1 2 described in large dermatol- ogy series to 60 80 from rheumatology clinics.

This wide variability in the reported prevalence suggests that documentation of rheumatologic signs and symp- toms depends on the specialty in which the patient is being treated, and rheumatic manifestations of leprosy as a whole is often under-reported by non-rheumatol- ogy services.

Therefore, it is a felt need for awareness of the condition among rheumatologists, as joint involve- ment can be the only manifestation in some cases.

EPIDEMIOLOGY The World Health Organization (WHO) achieved the elimination of leprosy as a public health problem (prevalence less than one case per 10 000 persons) globally in the year 2000.

The annual leprosy statistics in 2015 from 121 countries indicate that leprosy still exists at least in small numbers of cases in many coun- tries.

In 2014, 213 899 new cases were reported in the world; 94 of these were from 13 high endemic coun- tries, with the remaining 6 of new cases from the 108 other countries.

The leprosy control program now aims to focus on the 13 most highly endemic countries in order to achieve its targets.

Most of these endemic countries belong to SEA and Central America.

Lepromatous manifestations are most often seen in males across all series.

These are more common in peo- ple from rural areas although some studies have found equal prevalence in rural and urban areas.

Although rheumatologic manifestations can be seen in all types of leprosy, these are more common in the lepromatous variety.

CLINICAL FEATURES The classic manifestations of leprosy vary from macules to plaques and nodules, which are often hypo-pigmen- ted or hypo-anesthetic.

Neurologic manifestations can range from mononeuropathy to mononeuritis multi- plex and distal symmetric polyneuropathy.

Charcots arthropathy is the classic rheumatologic manifestation of leprosy often described in textbooks; it is usually seen in long-standing cases with neurologic involvement.

Findings may range from subluxation, dislo- cation or pathologic fractures to complete joint destruc- tion.

Although it is deemed to be prevalent in one in 10 cases, data from rheumatology units has yielded a sur- prisingly lower number.

This change could also be attributable to the early and widespread use of mul- tidrug therapy (MDT).

Interestingly, a plethora of rheumatologic phenomena may be uncovered in a host with poor immunity after the initiation of MDT.

Asia Pacic League of Associations for Rheumatology and John Wiley Sons Australia, Ltd International Journal of Rheumatic Diseases 2016; 19: 941945.

Small joints of the hands and feet are most commonly involved, although knees and elbows can be affected.

These usually last for a few weeks and resolve com- pletely with treatment, although recurrences have been described.

Leprosy can also have chronic polyarthritis resem- bling rheumatoid arthritis (RA).

Harrison Rheumatology 4Th Year Pdf