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KMID : 0376219810180010069
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Chonnam Medical Journal
1981 Volume.18 No. 1 p.69 ~ p.76
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Bone and Joint Changes in Leprosy
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崔在權/Choi, Jae Kwon
尹在龍/鄭然泰/裵椿祥/Yoon, Jae Rhyong/Chung, Yeun Tae/Bae, Choon Sang
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Abstract
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The changes in bones and joints of the limbs were studied with histological and roentgenological and electron microscopical methods in 40 samples of phalangeal bones taken from 21 patients with lepromatous or tuberculoid leprosy. Results were obtained as follows.
Radiological and histological changes in the bones of leprosy patients were classified into specific and non-specific varieties. The radiological appearence of specific bone changes were noted as generalized osteoporosis or as localized area of destruction. Ulceration and inflammation often noted in the amputated tissues appeared to be caused by sensory loss due to the nerve involvement of the leprosy, and therefore these changes were non-specific. Radiological features of these non-specific bone changes were recognized as bone fragmentation, gross bone destruction and deformity of the affected bones. Joint involvement in the limbs of leprosy was almost always associated with adjacent ulceration. In non-specific arthritis, destruction of articular surfaces and diminution of the joint space were noted.
Histologically, in all advanced cases lepromatous granulation was extended into the bone, and the bony trabeculae was gradually eroded and destoryed. The bone marrow was infiltrated by macrophages and lymphocytes. In area where inflammatory reaction was pronounced necrosis of bone and minute fragments of dead bone were often observed. In the interphalangeal joints subsynovium was infiltrated by granulation tissue and showed various degrees of hyperplasia and vascularity. Articular cartilages were also involved by lepromatous granulation tissue, and the superficial layer of the cartilage showed fibrillation and indentation.
Electron microscopy of articular cartillage cells showed fragmentation of cell processes and mitochondrial swelling with minimal changes in granular endoplasmic reticulum and other cell organells.
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