{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,3]],"date-time":"2026-11-03T03:55:17Z","timestamp":1793678117926,"version":"4.5.1"},"reference-count":98,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2023,9,25]],"date-time":"2023-09-25T00:00:00Z","timestamp":1695600000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:p>Leprosy is an infectious and contagious disease of slow evolution, triggered by <jats:italic>Mycobacterium leprae<\/jats:italic>. Arthritis is its third most common manifestation, after cutaneous and peripheral nerve involvement. Since musculoskeletal symptoms may be the initial presentation of the disease, it is important for health professionals to recognize its rheumatic manifestations for early diagnosis and appropriate treatment, especially in endemic areas. In addition, cases of leprosy have increased globally, notably in patients undergoing treatment with TNF-\u03b1 blockers and due to the increase in migration and travel of people from developing countries to developed countries. This review proposes to discuss the main scenarios of mimicry of different rheumatic diseases by leprosy, as well as the role of immunosuppressive drugs used in rheumatology practice in the treatment of reactional states and in the risk of developing the infection.<\/jats:p>","DOI":"10.3389\/fmed.2023.1239775","type":"journal-article","created":{"date-parts":[[2023,9,27]],"date-time":"2023-09-27T12:41:02Z","timestamp":1695818462000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":10,"title":["New insights at the interface between leprosy and immune-mediated rheumatic diseases"],"prefix":"10.3389","volume":"10","author":[{"given":"Vitor Alves","family":"Cruz","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cleandro Pires de","family":"Albuquerque","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria Fernanda Brand\u00e3o de Resende","family":"Guimar\u00e3es","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carla da Fontoura","family":"Dionello","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sandra L\u00facia Euz\u00e9bio","family":"Ribeiro","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Viviane Angelina de","family":"Souza","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ciro Martins","family":"Gomes","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Licia Maria Henrique da","family":"Mota","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2023,9,25]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"8652062","DOI":"10.1155\/2022\/8652062","article-title":"Leprosy: a review of epidemiology, clinical diagnosis, and management","volume":"2022","author":"Chen","year":"2022","journal-title":"J Trop Med"},{"key":"ref2","year":"2023"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"338","DOI":"10.1016\/j.abd.2021.08.006","article-title":"Leprosy: clinical and immunopathological characteristics","volume":"97","author":"Froes","year":"2022","journal-title":"An Bras Dermatol"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"389","DOI":"10.1590\/abd1806-4841.20175423","article-title":"Lepromatous leprosy simulating rheumatoid arthritis - report of a neglected disease","volume":"92","author":"Andrade","year":"2017","journal-title":"An Bras Dermatol"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"567","DOI":"10.3389\/fimmu.2020.00567","article-title":"Advances in the immunology and genetics of leprosy","volume":"11","author":"Mi","year":"2020","journal-title":"Front Immunol"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"536","DOI":"10.1590\/S0074-02762011000500003","article-title":"Early detection of leprosy by examination of household contacts, determination of serum anti-PGL-1 antibodies and consanguinity","volume":"106","author":"Bazan-Furini","year":"2011","journal-title":"Mem Inst Oswaldo Cruz"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"1143402","DOI":"10.3389\/fmed.2023.1143402","article-title":"Early diagnosis of neural impairment in seropositive leprosy household contacts: the experience of a reference center in Brazil","volume":"10","author":"Dos Santos","year":"2023","journal-title":"Front Med"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"2237","DOI":"10.1093\/rheumatology\/keq264","article-title":"Arthritis in leprosy","volume":"49","author":"Chauhan","year":"2010","journal-title":"Rheumatology (Oxford)"},{"key":"ref9","doi-asserted-by":"crossref","first-page":"277","DOI":"10.3889\/oamjms.2021.7629","article-title":"Leprosy mimicking as rheumatoid arthritis: a case report","volume":"9","author":"Sridana","year":"2021","journal-title":"Open Access Maced J Med Sci"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"1557","DOI":"10.1007\/s10067-013-2276-5","article-title":"Leprosy in a rheumatology setting: a challenging mimic to expose","volume":"32","author":"Salvi","year":"2013","journal-title":"Clin Rheumatol"},{"key":"ref11","first-page":"29","article-title":"Leprous synovitis. A study of fifty cases","volume":"51","author":"Holla","year":"1983","journal-title":"Int J Leprosy"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"79","DOI":"10.1007\/s10067-008-0986-x","article-title":"Leprosy-related joint involvement","volume":"28","author":"Pereira","year":"2009","journal-title":"Clin Rheumatol"},{"key":"ref13","first-page":"76","article-title":"A study of rheumatological manifestations of leprosy","volume":"70","author":"Vengadakrishnan","year":"2004","journal-title":"Indian J Dermatol Venereol Leprol"},{"key":"ref14","first-page":"165","article-title":"Rheumatological manifestations of leprosy","volume":"106","author":"Mandal","year":"2008","journal-title":"J Indian Med Assoc"},{"key":"ref15","doi-asserted-by":"publisher","first-page":"1024","DOI":"10.1111\/1756-185X.12668","article-title":"Evaluation of rheumatoid factor and anti-citrullinated peptide antibodies in relation to rheumatological manifestations in patients with leprosy from southern Brazil","volume":"19","author":"Dionello","year":"2016","journal-title":"Int J Rheum Dis"},{"key":"ref16","first-page":"111","article-title":"Articular inflammatory manifestations in patients with diferente forms of leprosy","volume":"25","author":"Cossermelli-Messina","year":"1998","journal-title":"J Rheumatol"},{"key":"ref17","doi-asserted-by":"publisher","first-page":"1316","DOI":"10.4269\/ajtmh.19-0723","article-title":"Case report: leprosy osteoarticular alterations mimicking rheumatoid arthritis","volume":"102","author":"Do Esp\u00edrito Santo","year":"2020","journal-title":"Am J Trop Med Hyg"},{"key":"ref18","doi-asserted-by":"crossref","first-page":"734","DOI":"10.1186\/2193-1801-3-734","article-title":"Case of arthritis secondary to leprosy","volume":"15","author":"Alam","year":"2014","journal-title":"Springerplus"},{"key":"ref19","doi-asserted-by":"publisher","first-page":"e328","DOI":"10.1371\/journal.pntd.0000328","article-title":"Enumeration of Mycobacterium leprae using real-time PCR","volume":"2","author":"Truman","year":"2008","journal-title":"PLoS Negl Trop Dis"},{"key":"ref20","doi-asserted-by":"publisher","first-page":"17","DOI":"10.22099\/mbrc.2020.35658.1464","article-title":"Molecular detection of Mycobacterium lepraeusing RLEP-PCR in post elimination era of leprosy","volume":"9","author":"Mohanty","year":"2020","journal-title":"Mol Biol Res Commun"},{"key":"ref21","doi-asserted-by":"publisher","first-page":"160","DOI":"10.1007\/s12026-014-8596-y","article-title":"Lupus and leprosy: beyond the coincidence","volume":"61","author":"Ribeiro","year":"2015","journal-title":"Immunol Res"},{"key":"ref22","doi-asserted-by":"publisher","first-page":"2062","DOI":"10.1136\/annrheumdis-2012-201485","article-title":"The development of arthritis and antinuclear antibodies correlate with serum 25-hydroxyvitamin D levels in patients with leprosy","volume":"71","author":"Ribeiro","year":"2012","journal-title":"Ann Rheum Dis"},{"key":"ref23","doi-asserted-by":"publisher","first-page":"1095","DOI":"10.1177\/0961203315574557","article-title":"Multibacillary leprosy mimicking systemic lupus erythematosus: case report and literature review","volume":"24","author":"Horta-Baas","year":"2015","journal-title":"Lupus"},{"key":"ref24","doi-asserted-by":"publisher","first-page":"85","DOI":"10.1590\/S0037-86822011000100019","article-title":"Application of the diagnostic criteria for systemic lupus erythematosus to patients with multibacillary leprosy","volume":"44","author":"Teixeira Junior","year":"2011","journal-title":"Rev Soc Bras Med Trop"},{"key":"ref25","first-page":"123","article-title":"Leprosy: a great mimicking disease","volume":"88","author":"Garg","year":"2016","journal-title":"Indian J Lepr"},{"key":"ref26","doi-asserted-by":"publisher","first-page":"1293","DOI":"10.1007\/s10067-022-06090-6","article-title":"Neglected tropical rheumatic diseases","volume":"41","author":"Sahoo","year":"2022","journal-title":"Clin Rheumatol"},{"key":"ref27","doi-asserted-by":"publisher","first-page":"e251497","DOI":"10.1136\/bcr-2022-251497","article-title":"Multibacillary leprosy with positive serology misdiagnosed as systemic lupus erythematosus","volume":"15","author":"Shoela","year":"2022","journal-title":"BMJ Case Rep"},{"key":"ref28","first-page":"529","article-title":"Comparison between autoantibodies in malaria and leprosy with lupus","volume":"70","author":"Bonfa","year":"1987","journal-title":"Clin Exp Immunol"},{"key":"ref29","doi-asserted-by":"publisher","first-page":"1106","DOI":"10.1136\/ard.62.11.1106","article-title":"Anticardiolipin anti-beta2-glycoprotein I and antiprothrombin antibodies in black South African patients with infectious disease","volume":"62","author":"Loizou","year":"2003","journal-title":"Ann Rheum Dis"},{"key":"ref30","first-page":"30","article-title":"Anti-\u00df2 glycoprotein I antibodies are highly prevalent in a large number of Brazilian leprosy patients","volume":"36","author":"Ribeiro","year":"2011","journal-title":"Acta Reumatol Port"},{"key":"ref31","first-page":"30","article-title":"Imaging methods evaluation in osteoarticular and peripheral nerves involvement in leprosy","volume":"46","author":"Pereira","year":"2006","journal-title":"Rev Bras Reumatol"},{"key":"ref32","doi-asserted-by":"publisher","first-page":"630","DOI":"10.1016\/j.rbr.2016.08.001","article-title":"Leprosy simulating systemic sclerosis: a case report","volume":"57","author":"Chu","year":"2017","journal-title":"Rev Bras Reumatol"},{"key":"ref33","doi-asserted-by":"publisher","first-page":"2179","DOI":"10.1007\/s00415-015-7864-7","article-title":"An inflammatory myopathy unmasks a case of leprosy in an Italian patient","volume":"262","author":"Liguori","year":"2015","journal-title":"J Neurol"},{"key":"ref34","doi-asserted-by":"publisher","first-page":"e12950","DOI":"10.1111\/bpa.12950","article-title":"Infective myositis","volume":"31","author":"Narayanappa","year":"2021","journal-title":"Brain Pathol"},{"key":"ref35","doi-asserted-by":"crossref","first-page":"442","DOI":"10.1097\/00005792-198011000-00004","article-title":"The rheumatic manifestations of leprosy","volume":"59","author":"Albert","year":"1982","journal-title":"Medicine"},{"key":"ref36","doi-asserted-by":"publisher","first-page":"463","DOI":"10.3389\/fimmu.2018.00463","article-title":"miRNome expression analysis reveals new players on leprosy immune physiopathology","volume":"9","author":"Salgado","year":"2018","journal-title":"Front Immunol"},{"key":"ref37","doi-asserted-by":"publisher","first-page":"229","DOI":"10.1186\/ar3377","article-title":"MicroRNAs in systemic rheumatic diseases","volume":"13","author":"Ceribelli","year":"2011","journal-title":"Arthritis Res Ther"},{"key":"ref38","doi-asserted-by":"publisher","first-page":"129","DOI":"10.1111\/j.1756-185X.2012.01819.x","article-title":"Leprosy revealed in a rheumatology clinic: a case series","volume":"16","author":"Prasad","year":"2013","journal-title":"Int J Rheum Dis"},{"key":"ref39","doi-asserted-by":"crossref","first-page":"457","DOI":"10.1016\/j.jped.2014.01.007","article-title":"Musculoskeletal manifestations and autoantibodies in children and adolescents with leprosy","volume":"90","author":"Neder","year":"2014","journal-title":"J Pediatr"},{"key":"ref40","doi-asserted-by":"publisher","first-page":"715","DOI":"10.1136\/ard.49.9.715","article-title":"Clinical and laboratory studies in patients with leprosy and enthesitis","volume":"49","author":"Atkin","year":"1990","journal-title":"Ann Rheum Dis"},{"key":"ref41","first-page":"1020","article-title":"Enthesopathy in leprosy","volume":"23","author":"Carpintero-Ben\u00edtez","year":"1996","journal-title":"J Rheumatol"},{"key":"ref42","doi-asserted-by":"publisher","first-page":"e350","DOI":"10.1093\/rheumatology\/keac189","article-title":"Musculoskeletal manifestations of leprosy","volume":"61","author":"Belani","year":"2022","journal-title":"Rheumatology"},{"key":"ref43","doi-asserted-by":"publisher","first-page":"870584","DOI":"10.3389\/fmed.2022.870584","article-title":"Can leprosy reaction states mimic symptoms of fibromyalgia? A cross-sectional analytical study","volume":"9","author":"Feitosa","year":"2022","journal-title":"Front Med"},{"key":"ref44","doi-asserted-by":"publisher","first-page":"77","DOI":"10.1590\/S0482-50042006000100016","article-title":"Fibromialgia e rea\u00e7\u00e3o hans\u00eanica","volume":"46","author":"Carneiro","year":"2006","journal-title":"Rev Bras Reumatol"},{"key":"ref45","doi-asserted-by":"publisher","first-page":"635","DOI":"10.4103\/ijd.IJD_115_17","article-title":"Use of fine needle aspirate from peripheral nerves of pure-neural leprosy for cytology and polymerase chain reaction to confirm the diagnosis: a followup study of 4 years","volume":"62","author":"De","year":"2017","journal-title":"Indian J Dermatol"},{"key":"ref46","doi-asserted-by":"publisher","first-page":"64","DOI":"10.1016\/S0165-5728(00)00190-9","article-title":"Detection of disease related immune complexes in the serum of leprosy patients. A novel single step method","volume":"105","author":"Patil","year":"2000","journal-title":"J Neuroimmunol"},{"key":"ref47","doi-asserted-by":"publisher","first-page":"52","DOI":"10.1186\/s42358-019-0094-4","article-title":"Epidemiological, clinical and immune factors that influence the persistence of antiphospholipid antibodies in leprosy","volume":"59","author":"Ribeiro","year":"2019","journal-title":"Adv Revista Brasileira de Reumatol"},{"key":"ref48","doi-asserted-by":"publisher","first-page":"594","DOI":"10.1191\/096120300678828712","article-title":"High prevalence of antiphospholipid antibodies in leprosy: evaluation of antigen reactivity","volume":"9","author":"De Larra\u00f1aga","year":"2000","journal-title":"Lupus"},{"key":"ref49","doi-asserted-by":"publisher","first-page":"e20180385","DOI":"10.1590\/0037-8682-0385-2018","article-title":"Adverse events in patients with leprosy on treatment with thalidomide","volume":"52","author":"Drummond","year":"2019","journal-title":"Rev Soc Bras Med Trop"},{"key":"ref50","doi-asserted-by":"publisher","first-page":"347","DOI":"10.1111\/cup.13425","article-title":"Lucio phenomenon mimicking antiphospholipid syndrome: the occurrence of antiphospholipid antibodies in a leprosy patient","volume":"46","author":"Guevara","year":"2019","journal-title":"J Cutan Pathol"},{"key":"ref51","doi-asserted-by":"publisher","first-page":"114","DOI":"10.4103\/0019-5154.94278","article-title":"A retrospective analysis of histopathology of 64 cases of lepra reactions","volume":"57","author":"Adhe","year":"2012","journal-title":"Indian J Dermatol"},{"key":"ref52","doi-asserted-by":"publisher","first-page":"e0006011","DOI":"10.1371\/journal.pntd.0006011","article-title":"Clinico-pathological features of erythema nodosum leprosum: a case-control study at ALERT hospital, Ethiopia","volume":"11","author":"Negera","year":"2017","journal-title":"PLoS Negl Trop Dis"},{"key":"ref53","doi-asserted-by":"publisher","first-page":"222","DOI":"10.5826\/dpc.0903a13","article-title":"A case of lepromatous leprosy clinically masquerading as Vasculitis","volume":"9","author":"Sadeghinia","year":"2019","journal-title":"Dermatol Pract Concept"},{"key":"ref54","doi-asserted-by":"publisher","first-page":"15","DOI":"10.1590\/S0036-46652015000100002","article-title":"Leprosy nephropathy: a review of clinical and histopathologicalfeatures","volume":"57","author":"Da Silva Junior","year":"2015","journal-title":"Rev Inst Med Trop S\u00e3o Paulo"},{"key":"ref55","doi-asserted-by":"publisher","first-page":"641989","DOI":"10.1155\/2014\/641989","article-title":"Lepra reaction with lucio phenomenon mimicking cutaneous vasculitis","volume":"2014","author":"Misra","year":"2014","journal-title":"Case Reports Immunol"},{"key":"ref56","doi-asserted-by":"publisher","first-page":"378","DOI":"10.1590\/S1413-86702007000300016","article-title":"Vasculonecrotic reactions in leprosy","volume":"11","author":"Fogagnolo","year":"2007","journal-title":"Brazilian J Infect Dis"},{"key":"ref57","doi-asserted-by":"publisher","first-page":"464","DOI":"10.25259\/IJDVL_909_19","article-title":"Lucio\u2019s phenomenon: a systematic literature review of definition, clinical features, histopathogenesis and management","volume":"88","author":"Frade","year":"2022","journal-title":"Indian J Dermatol Venereol Leprol"},{"key":"ref58","doi-asserted-by":"publisher","first-page":"555","DOI":"10.1097\/DAD.0b013e318181270a","article-title":"Lucio\u2019s phenomenon is a necrotizing panvasculitis: mostly a medium-sized granulomatous arteritis","volume":"30","author":"Maga\u00f1a","year":"2008","journal-title":"Am J Dermatopathol"},{"key":"ref59","doi-asserted-by":"publisher","first-page":"140","DOI":"10.1590\/S0482-50042007000200013","article-title":"Vasculitis in leprosy mimicking rheumatic diseases","volume":"47","author":"Ribeiro","year":"2007","journal-title":"Rev Bras Reumatol"},{"key":"ref60","first-page":"61","article-title":"Hansen\u2019 s disease mimicking a systemic vasculitis","volume":"36","author":"Sampaio","year":"2011","journal-title":"Acta Reumatol Port"},{"key":"ref61","doi-asserted-by":"publisher","first-page":"2004","DOI":"10.1097\/CM9.0000000000000937","article-title":"Recurrent fever and cutaneous nodules: leprosy masquerading as anti-neutrophil cytoplasmic antibodies associated vasculitis","volume":"133","author":"Yu","year":"2020","journal-title":"Chin Med J"},{"key":"ref62","doi-asserted-by":"publisher","first-page":"270","DOI":"10.1093\/rheumatology\/37.3.270","article-title":"Anti-neutrophil cytoplasmic autoantibodies in leprosy","volume":"37","author":"Medina","year":"1998","journal-title":"Br J Rheumatol"},{"key":"ref63","doi-asserted-by":"publisher","first-page":"50","DOI":"10.47276\/lr.75.1.50","article-title":"Increased incidence of cytoplasmic ANCA (cANCA) and other autoantibodies in leprosy patients from Western India","volume":"75","author":"Pradhan","year":"2004","journal-title":"Lepr Rev"},{"key":"ref64","doi-asserted-by":"publisher","first-page":"1035","DOI":"10.1111\/1756-185X.12916","article-title":"Leprae reaction resembling rheumatologic disease as presenting feature of leprosy","volume":"19","author":"Baharuddin","year":"2016","journal-title":"Int J Rheum Dis"},{"key":"ref65","doi-asserted-by":"publisher","first-page":"496","DOI":"10.1136\/jnnp.68.4.496","article-title":"Vasculitic neuropathy in a patient with inactive treated lepromatous leprosy","volume":"68","author":"Bowen","year":"2000","journal-title":"J Neurol Neurosurg Psychiatry"},{"key":"ref66","doi-asserted-by":"publisher","first-page":"e236796","DOI":"10.1136\/bcr-2020-236796","article-title":"Leprosy mimicking rheumatoid vasculitis with scleromalacia perforans","volume":"13","author":"Manoj","year":"2020","journal-title":"BMJ Case Rep"},{"key":"ref67","doi-asserted-by":"publisher","first-page":"85","DOI":"10.1093\/rheumatology\/key216","article-title":"Necrotic erythema nodosum leprosum masquerading as cutaneous vasculitis","volume":"58","author":"Bhattacharjee","year":"2019","journal-title":"Rheumatology"},{"key":"ref68","doi-asserted-by":"publisher","first-page":"372","DOI":"10.47276\/lr.79.4.372","article-title":"Leprosy type 1 (reversal) reactions and their management","volume":"79","author":"Walker","year":"2008","journal-title":"Lepr Rev"},{"key":"ref69","doi-asserted-by":"publisher","first-page":"146","DOI":"10.1038\/cmi.2016.39","article-title":"Immunosuppression for in vivo research: state-of-the-art protocols and experimental approaches","volume":"14","author":"Diehl","year":"2017","journal-title":"Cell Mol Immunol."},{"key":"ref70","doi-asserted-by":"publisher","first-page":"338","DOI":"10.1128\/CMR.19.2.338-381.2006","article-title":"The continuing challenges of leprosy","volume":"19","author":"Scollard","year":"2006","journal-title":"Clin Microbiol Rev"},{"key":"ref71","first-page":"178","article-title":"Chloroquine for reactions in leprosy","volume":"31","author":"MukerJee","year":"1963","journal-title":"Int J Lepr"},{"key":"ref72","doi-asserted-by":"publisher","first-page":"1138","DOI":"10.1016\/s0140-6736(64)92664-9","article-title":"Effect of cyclophosphamide on leprosy. Competitive action of cyclophosphamide and dapsone","volume":"2","author":"Davison","year":"1964","journal-title":"Lancet"},{"key":"ref73","doi-asserted-by":"publisher","first-page":"101670","DOI":"10.1016\/j.tmaid.2020.101670","article-title":"Use of methotrexate for leprosy reactions. Experience of a referral center and systematic review of the literature","volume":"37","author":"Perez-Molina","year":"2020","journal-title":"Travel Med Infect Dis"},{"key":"ref74","doi-asserted-by":"publisher","first-page":"118","DOI":"10.47276\/lr.87.1.118","article-title":"Management of chronic neuritis with a combination regimen of lower doses prednisolone and methotrexate: a brief report","volume":"87","author":"Hossain","year":"2016","journal-title":"Lepr Rev"},{"key":"ref75","doi-asserted-by":"publisher","first-page":"379","DOI":"10.47276\/lr.86.4.379","article-title":"Effectiveness of methotrexate in prednisolone and halidomide resistant cases of type 2 lepra reaction: report on three cases","volume":"86","author":"Nagar","year":"2015","journal-title":"Lepr Rev"},{"key":"ref76","doi-asserted-by":"publisher","first-page":"e7","DOI":"10.1086\/518699","article-title":"Methotrexate treatment for type 1 (reversal) leprosy reactions","volume":"45","author":"Biosca","year":"2007","journal-title":"Clin Infect Dis"},{"key":"ref77","doi-asserted-by":"publisher","first-page":"602","DOI":"10.1016\/j.trstmh.2003.12.013","article-title":"Clinical outcomes in a randomized controlled study comparing azathioprine and prednisolone versus prednisolone alone in the treatment of severe leprosy type 1 reactions in Nepal","volume":"98","author":"Marlowe","year":"2004","journal-title":"Trans R Soc Trop Med Hyg"},{"key":"ref78","doi-asserted-by":"publisher","first-page":"e0005348","DOI":"10.1371\/journal.pntd.0005348","article-title":"AZALEP a randomized controlled trial of azathioprine to treat leprosy nerve damage and type 1 reactions in India: main findings","volume":"11","author":"Lockwood","year":"2017","journal-title":"PLoS Negl Trop Dis"},{"key":"ref79","first-page":"127","article-title":"The role of mycophenolate mofetil in the treatment of leprosy reactions","volume":"73","author":"Burdick","year":"2005","journal-title":"Int J Lepr Other Mycobact Dis"},{"key":"ref80","doi-asserted-by":"publisher","first-page":"142","DOI":"10.4103\/0019-5154.43205","article-title":"Management of erythema nodosum leprosum by mycophenolate mofetil","volume":"53","author":"Banerjee","year":"2008","journal-title":"Indian J Dermatol"},{"key":"ref81","doi-asserted-by":"publisher","first-page":"15","DOI":"10.1159\/000517993","article-title":"Cyclosporin a as an alternative neuroimmune strategy to control neurites and recover neuronal tissues in leprosy","volume":"29","author":"Jesus","year":"2022","journal-title":"Neuroimmunomodulation"},{"key":"ref82","doi-asserted-by":"publisher","first-page":"121","DOI":"10.47276\/lr.77.2.121","article-title":"Cyclosporine a treatment of leprosy patients with chronic neuritis is associated with pain control and reduction in antibodies against nerve growth factor","volume":"77","author":"Sena","year":"2006","journal-title":"Lepr Rev"},{"key":"ref83","doi-asserted-by":"publisher","first-page":"721","DOI":"10.1016\/j.ccm.2019.07.003","article-title":"Tuberculosis and biologic therapies: anti-tumor necrosis factor-\u03b1 and beyond","volume":"40","author":"Godfrey","year":"2019","journal-title":"Clin Chest Med [Internet]"},{"key":"ref84","doi-asserted-by":"publisher","first-page":"e19","DOI":"10.1086\/505222","article-title":"Development of leprosy and type 1 leprosy reactions after treatment with infliximab: a report of 2 cases","volume":"43","author":"Scollard","year":"2006","journal-title":"Clin Infect Dis"},{"key":"ref85","first-page":"336","article-title":"Lepromatous leprosy associated with the use of anti-TNF \u03b1 therapy: case report","volume":"50","author":"Freitas","year":"2010","journal-title":"Rev Bras Reumatol"},{"key":"ref86","doi-asserted-by":"publisher","first-page":"615","DOI":"10.1007\/s10067-009-1140-0","article-title":"Development of leprosy in a patient with ankylosing spondylitis during the infliximab treatment: reactivation of a latent infection?","volume":"28","author":"Vilela Lopes","year":"2009","journal-title":"Clin Rheumatol"},{"key":"ref87","doi-asserted-by":"crossref","first-page":"269","DOI":"10.1097\/RHU.0b013e3182288870","article-title":"Secondary leprosy infection in a patient with psoriasis during treatment with infliximab","volume":"17","author":"Teixeira","year":"2011","journal-title":"J Clin Rheumatol"},{"key":"ref88","doi-asserted-by":"publisher","first-page":"127","DOI":"10.1016\/j.semarthrit.2012.03.003","article-title":"Development of leprosy in a patient with rheumatoid arthritis during treatment with Etanercept: a case report","volume":"42","author":"Lluch","year":"2012","journal-title":"Semin Arthritis Rheum"},{"key":"ref89","first-page":"23","article-title":"Agentes biol\u00f3gicos: Pesquisa de hansen\u00edase e outras doen\u00e7as infecciosas antes da indica\u00e7\u00e3o","volume":"88","author":"Ant\u00f3nio","year":"2013","journal-title":"An Bras Dermatol"},{"key":"ref90","doi-asserted-by":"publisher","first-page":"347","DOI":"10.1186\/s12879-021-06041-7","article-title":"Leprosy detection rate in patients under immunosuppression for the treatment of dermatological, rheumatological, and gastroenterological diseases: a systematic review of the literature and meta-analysis","volume":"21","author":"Barroso","year":"2021","journal-title":"BMC Infect Dis"},{"key":"ref91","doi-asserted-by":"publisher","first-page":"1131","DOI":"10.4269\/ajtmh.19-0616","article-title":"Biologics in leprosy: a systematic review and case report","volume":"102","author":"Cogen","year":"2020","journal-title":"Am J Trop Med Hyg"},{"key":"ref92","doi-asserted-by":"crossref","first-page":"e21","DOI":"10.1111\/jdv.16764","article-title":"The risk of leprosy in patients using immunobiologics and conventional immunosuppressants for the treatment of dermatological and rheumatological diseases: a cohort study","volume":"35","author":"Martins Gomes","year":"2021","journal-title":"J Eur Acad Dermatology Venereol"},{"key":"ref93","doi-asserted-by":"publisher","first-page":"223","DOI":"10.1016\/j.ijmyco.2016.02.002","article-title":"Treatment of severe refractory erythema nodosum leprosum with tumor necrosis factor inhibitor Etanercept","volume":"5","author":"Chowdhry","year":"2016","journal-title":"Int J Mycobacteriology"},{"key":"ref94","doi-asserted-by":"publisher","first-page":"575","DOI":"10.1590\/abd1806-4841.20175471","article-title":"Etanercept in erythema nodosum leprosum","volume":"92","author":"Santos","year":"2017","journal-title":"An Bras Dermatol"},{"key":"ref95","doi-asserted-by":"publisher","first-page":"739","DOI":"10.1056\/NEJMc052955","article-title":"Treatment of recurrent erythema nodosum leprosum with infliximab","volume":"355","author":"Faber","year":"2006","journal-title":"N Engl J Med"},{"key":"ref96","doi-asserted-by":"publisher","first-page":"879527","DOI":"10.3389\/fmed.2022.879527","article-title":"Case report: a case series of immunobiological therapy (anti-TNF-\u03b1) for patients with erythema nodosum leprosum","volume":"9","author":"Mendes","year":"2022","journal-title":"Front Med"},{"key":"ref97","doi-asserted-by":"publisher","first-page":"e133","DOI":"10.1093\/cid\/ciq213","article-title":"Severe refractory erythema nodosum leprosum successfully treated with the tumor necrosis factor inhibitor etanercept","volume":"52","author":"Ramien","year":"2011","journal-title":"Clin Infect Dis"},{"key":"ref98","doi-asserted-by":"publisher","first-page":"S290","DOI":"10.1093\/ofid\/ofy210.818","article-title":"811. A randomized controlled trial of prednisolone vs. interleukin 17 a inhibitor secuinumab in the management of type 1 lepra reaction in leprosy patients","volume":"5","author":"Mitra","year":"2018","journal-title":"Open Forum Infect Dis"}],"container-title":["Frontiers in Medicine"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2023.1239775\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,9,27]],"date-time":"2023-09-27T12:41:18Z","timestamp":1695818478000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2023.1239775\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,9,25]]},"references-count":98,"alternative-id":["10.3389\/fmed.2023.1239775"],"URL":"https:\/\/doi.org\/10.3389\/fmed.2023.1239775","relation":{},"ISSN":["2296-858X"],"issn-type":[{"value":"2296-858X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,9,25]]},"article-number":"1239775"}}