Musculoskeletal manifestations and autoantibodies in children and adolescents with leprosy

Neder, Luciana; Rondon, Daniel A.; Cury, Silvana S.; Silva, Clovis A. da

doi:10.1016/j.jped.2014.01.007

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Original Articles • J. Pediatr. (Rio J.) 90 (05) • Sep-Oct 2014 • https://doi.org/10.1016/j.jped.2014.01.007 copy

Musculoskeletal manifestations and autoantibodies in children and adolescents with leprosy^☆ ☆ Please cite this article as: Neder L, Rondon DA, Cury SS, da Silva CA. Musculoskeletal manifestations and autoantibodies in children and adolescents with leprosy. J Pediatr (Rio J). 2014;90:457–63.

Authorship SCIMAGO INSTITUTIONS RANKINGS

Objective:

To evaluate musculoskeletal involvement and autoantibodies in pediatric leprosy patients.

Methods:

50 leprosy patients and 47 healthy children and adolescents were assessed according to musculoskeletal manifestations (arthralgia, arthritis, and myalgia), musculoskeletal pain syndromes (juvenile fibromyalgia, benign joint hypermobility syndrome, myofascial syndrome, and tendinitis), and a panel of autoantibodies and cryoglobulins. Health assessment scores and treatment were performed in leprosy patients.

Results:

At least one musculoskeletal manifestation was observed in 14% of leprosy patients and in none of the controls. Five leprosy patients had asymmetric polyarthritis of small hands joints. Nerve function impairment was observed in 22% of leprosy patients, type 1 leprosy reaction in 18%, and silent neuropathy in 16%. None of the patients and controls presented musculoskeletal pain syndromes, and the frequencies of all antibodies and cyoglobulins were similar in both groups (p > 0.05). Further analysis of leprosy patients demonstrated that the frequencies of nerve function impairment, type 1 leprosy reaction, and silent neuropathy were significantly observed in patients with versus without musculoskeletal manifestations (p = 0.0036, p = 0.0001, and p = 0.309, respectively), as well as multibacillary subtypes in leprosy (86% vs. 42%, p = 0.045). The median of physicians' visual analog scale (VAS), patients' VAS, pain VAS, and Childhood Health Assessment Questionnaire (CHAQ) were significantly higher in leprosy patients with musculoskeletal manifestations (p = 0.0001, p = 0.002, p = 0002, and p = 0.001, respectively).

Conclusions:

This was the first study to identify musculoskeletal manifestations associated with nerve dysfunction in pediatric leprosy patients. Hansen's disease should be included in the differential diagnosis of asymmetric arthritis, especially in endemic regions.

Leprosy; Arthritis; Arthralgia; Neuropathy; Autoantibodies

Variables		Leprosy patients (n = 50)	Controls (n = 47)	p-value
Demographic data
	Current age, median (range)	12 (3-18)	14 (3-18)	0.385
	Female gender, n (%)	25 (50)	25 (53.1)	0.840
	Brazilian socio-economic classes
	Middle/lower middle class, n (%)	46 (92)	44 (93)	1.000
Clinical musculoskeletal manifestations
	Musculoskeletal, n (%)	7 (14)	0	0.0012^a a Significant p-values.
	Arthralgia, n (%)	1 (2)	0	1.000
	Myalgia, n (%)	3 (6)	0	0.243
Musculoskeletal pain syndromes
	Juvenile fibromyalgia, n (%)	0	0	1.000
	Benign joint hypermobility syndrome, n (%)	0	0	1.000
	Myofascial syndrome, n (%)	0	0	1.000
	Hands tendinitis, n (%)	0	0	1.000

Variables		Leprosy patients (n = 50)	Controls (n = 47)	p-value
Autoantibodies
	ANA, n (%)	1 (2)	0	1.000
	Anti-ds DNA, n (%)	0	0	1.000
	Anti-Ro, n (%)	0	0	1.000
	Anti-La, n (%)	0	0	1.000
	aCL-IgM, n (%)	8 (16)	6 (13)	0.775
	aCL-IgG, n (%)	1 (2)	0	1.000
	LAC, n (%)	1 (2)	1 (2)	1.000
	Cryoglobulins, n (%)	0	0	1.000

Variables		With musculoskeletal manifestations (n = 7)	Without musculoskeletal manifestations (n = 43)	p-value
Demographic data
	Disease onset, median (range)	12 (3-16)	10 (2-18)	0.286
	Current age, median (range)	13 (6-18)	12 (3-18)	0.280
	Female gender, n (%)	4 (57)	21 (49)	1.000
Brazilian socio-economic classes
	Middle/lower middle class, n (%)	7 (100)	35 (81)	0.579
Leprosy
	Nerve function impairment, n (%)	5 (71)	6 (14)	0.0036^a a Significant p-values.
	Type I (reversal) lepra reaction, n (%)	5 (71)	0	0.0001^a a Significant p-values.
	Silent neuropathy, n (%)	2 (29)	6 (14)	0.309
	Erythema nodosum leprosum, n (%)	0	0	1.000
	Cutaneous vasculitis, n (%)	0	0	1.000
	Multibacillary (BB, BL, or BT), n (%)	6 (86)	18 (42)	0.045^a a Significant p-values.
	Paucibacillary (TT or IL), n (%)	1 (14)	25 (58)	0.045^a a Significant p-values.
Health assessment scores
	Physician VAS (0-10), median (range)	8 (0-10)	0 (0-10)	0.0001^a a Significant p-values.
	Patient VAS (0-10), median (range)	0 (0-10)	0 (0-6)	0.002^a a Significant p-values.
	Pain VAS (0-10), median (range)	0 (0-9)	0 (0-8)	0.002^a a Significant p-values.
	CHAQ (0-3), median (range)	0 (0-1)	0 (0)	0.001^a a Significant p-values.
Treatment
	Prednisone, n (%)	5 (71)	0	0.0001^a a Significant p-values.
	Multibacillary therapy, n (%)	6 (86)	18 (42)	0.045^a a Significant p-values.
	Paucibacillary therapy, n (%)	1 (14)	25 (58)	0.045^a a Significant p-values.

Variables		With musculoskeletal manifestations (n = 7)	Without musculoskeletal manifestations (n = 43)	p-value
Autoantibodies
	ANA, n (%)	0	1 (2)	1.000
	Anti-ds DNA, n (%)	0	0	1.000
	Anti-Ro, n (%)	0	0	1.000
	Anti-La, n (%)	0	0	1.000
	aCL-IgM, n (%)	3 (43)	5 (12)	0.071
	aCL-IgG, n (%)	0	1 (2)	1.000
	LAC, n (%)	1 (14)	0	0.140
	Cryoglobulins, n (%)	0	0	1.000

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E-mail: jped@jped.com.br

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[1] * Corresponding author. E-mail: clovisaasilva@gmail.com (C.A. Silva).

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Musculoskeletal manifestations and autoantibodies in children and adolescents with leprosy☆ ☆ Please cite this article as: Neder L, Rondon DA, Cury SS, da Silva CA. Musculoskeletal manifestations and autoantibodies in children and adolescents with leprosy. J Pediatr (Rio J). 2014;90:457–63.

Objective:

Methods:

Results:

Conclusions:

Musculoskeletal manifestations and autoantibodies in children and adolescents with leprosy^☆ ☆ Please cite this article as: Neder L, Rondon DA, Cury SS, da Silva CA. Musculoskeletal manifestations and autoantibodies in children and adolescents with leprosy. J Pediatr (Rio J). 2014;90:457–63.