RESUMEN
It was found that some parasitic diseases could precipitate a wide complaint of rheumatic like pains. So, one hundred cases were chosen, among the patients who presented to the Outpatient Clinics of Rheumatology and Rehabilitation Department at Zagazig University Hospitals, [complaining of chronic, recurrent rheumatic pains, not responding to the usual non-steroidal antirheumatic treatment. They aged 25 - 50 years, of both sexes and from rural and urban areas. Full history taking, thorough physical and clinical examinations and complete laboratory investigations were done to: exclude other causes of rheumatic pains, diagnose and confirm the parasitic infections [using stool and urine analysis then IHAT]. 24% were found suffering from parasitic infections: 6 cases[6%] schistosomiasis, 4 amaebiasis [4%], 3 Toxoplasma infection [3%] and 2 toxocariasis [2%],3 cases had mixed parasitic infection [3%] 2 cases schistosomiasis and amaebiasis, 1 case shistosomiasis and toxoplasmosis], 6 cases [6%] were suffering from parasitic infection in addition to other cause of rheumatic pains. No significant difference were found among these different groups, regarding age, sex and residence.The usual clinical parasitic manifestations of dysentery diarrhoea, nausea'etc., were good criteria to evoke the diagnosis. Considering the erythrocyte sedimentation rate [E.S.R.] readings, a significant difference was found among schistosomal arthropathy group and other parasitic groups, that showed unsignificant differences.The clinical picture of arthritis induced by parasitic infections was non specific because it was usually accompanied by myalgia, sometimes knee joint effusion, as the clinical picture of different inflammatory rheumatic diseases.The role of Immune Complex [IC] in the pathogenesis of parasitic arthropathy, myopathy and joint effusion was discussed, on basis of the results of specific IC level estimation by micro-ELISA in the sera of the cases harbouring parasitic infections and synovial fluids [in cases with joint effusion], and compared with the results control group, a highly significant elevation was recorded in toxocariasis, significant rises reported in schistosomiasis and amaebiasis and a moderately significant increase noticed in toxoplasmosis. Also, IC was highly elevated in the synovial fluids above serum levels in cases of schistosomiasis, toxoplasmosis and toxocariasis with knee joint effusion, suggesting a secondary local immunological reactions. Therefore, it can be concluded that rheumatic like pains, related to some parasitic infections in our country as schistosomiasis, amaebiasis, toxoplasmosis and toxocariasis were due to immunological reactions, that IC, either in the serum or in the synovial fluid plays the major role, with probable minor roles played by excretory toxic metabolites of some parasites, others may cause limited direct catabolic effects in the joints and muscles. Thus, these parasitic infections as aetiological causes of chronic, and recurrent rheumatic - like pains should be considered wider than previously thought