RESUMO
Leprosy is generally revealed by cutaneous lesions often associated to nerve impairment. Rarely, it may be revealed by polyarthritis. The diagnosis, often delayed in the cutaneous-nevritic form because of the low prevalence of the disease in metropolitan France, is very difficult in case of rheumatic presentation. We report the case of a 28 year-old woman from Mali, who was diagnosed with lepromatous borderline leprosy with reversal reaction occurring in the postpartum as she presented with polyarthritis and skin lesions.
Assuntos
Artrite/etiologia , Hanseníase Dimorfa/diagnóstico , Hanseníase Virchowiana/diagnóstico , Administração Oral , Corticosteroides/administração & dosagem , Corticosteroides/uso terapêutico , Adulto , Biópsia , Clofazimina/administração & dosagem , Clofazimina/uso terapêutico , Dapsona/administração & dosagem , Dapsona/uso terapêutico , Quimioterapia Combinada , Feminino , Humanos , Hansenostáticos/administração & dosagem , Hansenostáticos/uso terapêutico , Hanseníase Dimorfa/complicações , Hanseníase Dimorfa/tratamento farmacológico , Hanseníase Dimorfa/patologia , Hanseníase Virchowiana/complicações , Hanseníase Virchowiana/tratamento farmacológico , Hanseníase Virchowiana/patologia , Rifampina/administração & dosagem , Rifampina/uso terapêutico , Pele/patologia , Resultado do TratamentoRESUMO
OBJECTIVE: To evaluate the short- and long-term efficacy of joint distention during arthrography followed by an intraarticular corticosteroid injection then by high-intensity physical therapy and use of an abduction splint in an open study of 40 patients with adhesive capsulitis of the shoulder. METHODS: Patients were evaluated on D0, D5 (i.e., before discharge) and D30 for pain severity assessed using a four-point scale (0-3) and for passive ranges of abduction, internal rotation and external rotation of the shoulder. RESULTS: Mean pain severity improved significantly from 2.18 +/- 0.6 (mean +/- SD) on D0 to 1.74 +/- 0.5 on D5 (P: 0.01) and 0.92 +/- 0.5 on D30 (P: 0.02). Passive range of abduction increased significantly from 44.8 degrees +/- 1.54 degrees on D0 to 68 degrees +/- 15 degrees on D5 (P: 0.05), whereas the difference between D5 and D30 (71 degrees +/- 13 degrees) was not significant (P: 0.8). Similarly, passive range of external rotation increased significantly from 4.3 degrees +/- 0.6 degree on D0 to 13.5 degrees +/- 0.5 degree on D5 (P = 0.04) and showed a nonsignificant increase from D5 to D30 (17 degrees +/- 13 degrees, P: 0.2). CONCLUSION: Joint distention during arthrography followed by an intraarticular corticosteroid injection then by high-intensity physical therapy significantly improved pain and passive range of motion within the first five days, and these gains were sustained after one month.
