Leprosy Mailing List – June 30, 2018
Ref.: (LML) Neural Leprosy and Rheumatoid Arthritis
From: Wim Theuvenet, Apeldoorn, the Netherlands
Dear Pieter,
Thank Dr. Tahir for the mail (LML, June 28, 2018).
From the description one may conclude that the lady her initial symptoms indeed seem to fit the classical diagnosis of PN leprosy with type 1 (+2) reaction)!! The swollen nerves and the loss of sensation and motor function are typical!
The spontaneous Swan neck deformities of her fingers and the wrist involvement which developed 8 yrs later do as Dr Schreuders suggest seem to fit best the diagnosis of Rheumatoid Arthritis. RA does not cause a swelling of nerves and loss of sensation can not be expected.
Has she a limitation in MCP full extension? In combination this may be caused by tightness of the intrinsic muscles in the palm of the hand. Are these tender? Are there signs of an arthritis at wrist or MCP level? as this would further support the RA diagnosis!.
Suggestion:
RA serology incl anti-CCP 2 and consultation by a rheumatologist.
Handtherapist can make oval-8 splints for the affected PIP joints to address the Swanneck deformities, while at night a splint to immobilise the fingers, hand and wrist may help to lengthen the intrinsic muscles.
In case of a RA arthritis a timely!! synovectomy of the inflamed synovia at wrist and MCP levels and of inflamed synovia around the tendons can often reduce pain and help in preventing more damage to the joints and in the rupturing of the inflamed tendons!
When any doubts remain please do not hesitate to contact again, we are interested in further developments!
With best regards,
Willem J.Theuvenet, M.D., Ph.D
Reconstructive Hand surgeon/ Leprologist
LML - S Deepak, B Naafs, S Noto and P Schreuder
LML blog link: http://leprosymailinglist.blogspot.it/
Contact: Dr Pieter Schreuder << editorlml@gmail.com
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