Hansen’s Disease and rheumatoid arthritis crossover of clinical symptoms: a case series of 18 patients in the United States

Background:

Hansen’s Disease (HD) is a rare, chronic granulomatous infection predominantly of the skin and peripheral nerves caused by the non-cultivable organism Mycobacterium leprae. After cutaneous and peripheral nerve manifestations, arthritis, either chronic or acute, has been identified as the third most common symptom of HD.

Methods:

Subjects with both confirmed HD on skin biopsy and chronic arthritis were selected based on tracking by the clinicians of the National Hansen’s Disease Program (NHDP) with IRB approval. De-identified information was extracted from charts on standardized forms and descriptive statistics performed.

Results:

We identified 18 patients of 261 seen from 2001-2015 at the NHDP in Baton Rouge, LA with both HD and chronic arthritis. Of these, 16/18 were male and 16/18 Caucasian. Fifteen of the 18 resided in Louisiana both at birth and at time of diagnosis of HD, and the average age at diagnosis of HD was 67 years, older than the national average for HD (Table 1). The majority (10/18) were diagnosed with borderline lepromatous (BL) leprosy, followed by 7/18 with lepromatous (LL) and 1/18 with borderline tuberculoid leprosy. Patients were symptomatic with arthritis for an average of 5.3 years prior to diagnosis with HD. Sixty-two percent of patients (11/18) were diagnosed with rheumatoid arthritis (RA) prior to diagnosis with HD, and among those, 10 of the 11 were seronegative RA. Hands (14/18), feet (11/18), wrists (9/18), and elbows (6/18) were the most commonly involved joints. Over half of the patients (11/18) had completed HD multi-drug therapy at the time of review, and of those 73% (8/11) had persistent joint pain requiring steroids and/or methotrexate for symptomatic control.

Conclusion:

Chronic arthritis/seronegative RA was the initial presentation of HD in this series of patients with US-acquired HD. Arthritis did not resolve with successful treatment of HD in most cases.

Table 1: Comparison of HD patients with chronic arthritis seen at NHDP 2001-2015 with all US cases reported 2004-2013

18 HD patients with chronic arthritis at NHDP, Baton Rouge, LA 2001-2015	1777 HD patients in US 2004-2013
89% male	69% male
89% Caucasian	25% Non-Hispanic White
100% US-born	23% US-born
83% Louisiana residents	8% Louisiana residents
39% LL	37% LL
56% BL	12% BL
100% >45 years of age at diagnosis	46% >45 years of age at diagnosis