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IMAGENOLOGICAL PROFILE OF LEPER PATIENTS WITH OSTEOARTICULAR MANIFESTATIONS FOLLOWED UP IN OUTPATIENTS CLINICS OF TERTIARY HOSPITAL
Leprosy is a chronic, infectious and granulomatous disease, mainly compromising the skin. Besides the classic osteoarticular lesions (neuropathic arthropathy; arthritis – specific septic or secondary to pyogenic infections), it is also described the inflammatory joint commitment. Osteoarthritic alterations and athropathy signs with joint space reduction can be verified in radiographies. The osteoarticular manifestations (OAM) usually happen during reactional episodes, specially in type 2 reaction (erythema nodosum leprosum).
The objective’s study was to draw an imagenological profile of the leper patients with OAM followed up in outpatients leprosy clinics of a tertiary hospital.
Materials and methods
The study was made involving leper patients with OAM. Out of 57 patients being followed up in the outpatients clinic, 35 participated of the study. Patients of both genders, with more than 18 years old, established diagnosis of leprosy and presence of OAM were included. Those in diagnostic investigation and those who did not agree in signing the free and informed consent were excluded. A questionnaire containing leprosy-related information was applied: clinical form, classification, time of diagnosis, leprosy reaction (LR) occurrence and OAM emergence time. The last were evaluated by questions involving clinical manifestations (pain, edema, heat, redness, morning stiffness, difficulty to initiate movements and crepitations) and imagenological findings (alterations found in radiographies and ultrasonographies of the impaired joints). Radiographies and ultrasonographies of the affected regions were realized in the leprosy service reference center with patients who had not previously made such exams. The ultrasonographies were made with high resolution convex transducer.
Out of the 35 patients with OAM, 46% (16) were submitted to imaging exams. 75% (12) of those presented alterations. Out of the patients with imagenological findings, 33% (4) showed modifications in wrists; 17% (2) in shoulders; 75% (9) in ankles; 17% (2) in proximal interphalangeals; and one patient in distal interphalangeals. 42% (5) presented thickening and hyperechogenicity in cutaneous and subcutaneous spaces; 33% (4), joint space reduction; 25% (3), bone texture reduction; 25% (3), periarticular bone porose; 17% (2), osteophytic formations; 17% (2), sugestive findings of tenosynovitis; 25% (3), tendinopathy signs; 17% (2), lymphedema; 17% (2), bursas thickening in shoulders; and 17% (2), enthesopathy signs.
The obtained data allow to affirm that the imaginological profile of the participants, as previously evidenced in literature, is mostly characterized by alterations such as joint space reduction, periarticular bone porose, thickening and hyperechogenicity in cutaneous and subcutaneous spaces and bone texture reduction, among others.
Gabriel Dias Américo, Guilherme Escarião de Morais Nóbrega, Joanne Elizabeth Ferraz da Costa, Alessandra Vanessa Bezerra de Albuquerque, Alessandra Sousa Braz