Hansen’s Disease and Rheumatoid Arthritis Crossover of Clinical Symptoms: A Case Series of 18 Patients in the United States

Sarah M. Labuda Tulane University School of Medicine, New Orleans, Louisiana;

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John S. Schieffelin Tulane University School of Medicine, New Orleans, Louisiana;

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Jeffrey G. Shaffer Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana;

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Barbara M. Stryjewska National Hansen’s Disease Program, Baton Rouge, Louisiana

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Hansen’s Disease (HD) is a rare, chronic granulomatous infection of the skin and peripheral nerves caused by the noncultivable organism Mycobacterium leprae. Arthritis is the third most common symptom of HD. Subjects with both confirmed HD on skin biopsy and chronic arthritis were identified at the National Hansen’s Disease Program (NHDP). We conducted a series of medical chart reviews and extracted and logged personally deidentified data into a database and carried out descriptive analyses. Eighteen of 261 subjects presented to the NDHP with both HD and chronic arthritis between 2001 and 2015. Among these, 16 were male, 16 were white, and 15 were residents of Louisiana. The median age at diagnosis of HD was 67 years. Ten of these subjects were diagnosed with borderline lepromatous leprosy, seven were diagnosed with lepromatous, and one was diagnosed with borderline tuberculoid leprosy. Patients were symptomatic with arthritis for a median of 5.3 years before HD diagnosis. Sixty-two percent of patients (11) were diagnosed with rheumatoid arthritis (RA) before HD diagnosis, and 10 of which were seronegative RA. Hands, feet, wrists, and elbows were most commonly reported as affected joints. Over half of the patients (61%) had completed HD multidrug therapy at the time of review, and 73% of these subjects had persistent joint pain requiring steroids or methotrexate for symptomatic control. Chronic arthritis in HD patients is present in a series of US-acquired cases of HD. Arthritis did not resolve with successful treatment of HD in most cases.

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Author Notes

Address correspondence to Sarah M. Labuda, Tulane University School of Medicine, 1440 Canal Street, Suite 1600, New Orleans, LA 70112-2632. E-mail: slabuda@tulane.edu

Financial support: J. S. S. received financial support from NIH grant 5K12HD043451.

Authors’ addresses: Sarah M. Labuda and John S. Schieffelin, Tulane University School of Medicine, New Orleans, LA, E-mails: slabuda@tulane.edu and jschieff@tulane.edu. Jeffrey G. Shaffer, Department of Global Biostatistics and Data Science, New Orleans, LA, E-mail: jshaffer@tulane.edu. Barbara M. Stryjewska, National Hansen’s Disease Program, Baton Rouge, LA, E-mail: bstryjewska@hrsa.gov.

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