{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,1]],"date-time":"2026-04-01T21:32:13Z","timestamp":1775079133335,"version":"3.50.1"},"reference-count":68,"publisher":"American Society of Tropical Medicine and Hygiene","issue":"4","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,4,1]]},"abstract":"<jats:title>ABSTRACT.<\/jats:title>\n                  <jats:p>Rheumatic manifestations are the third most common clinical features of Hansen\u2019s disease (HD), after cutaneous and neurological involvement. However, few studies have systematically characterized these manifestations, and most lack appropriate controls and standardized assessments. To address this gap, the present cross-sectional study was conducted to evaluate the rheumatic manifestations associated with HD. The study included 23 patients with HD and 23 age- and sex-matched non-HD controls from Puerto Rico. All participants underwent a standardized evaluation and examination for rheumatic features. Demographic data, clinical manifestations, comorbidities, and pharmacologic treatments were documented. Statistical analyses were performed using bivariate methods. The mean (SD) age of HD patients was 51.3 (15.7) years, and 60.8% were female. Regarding treatment status, 8.7% had received &lt;1 year of multidrug therapy (MDT), 8.7% had received at least 1 year of MDT, and 82.6% had completed therapy. Overall, 87% of HD patients presented with rheumatic manifestations, most commonly arthralgia (73.9%) and arthritis (69.6%). Compared with controls, HD patients exhibited a significantly higher proportion of arthritis, particularly involving the small joints of the hands, as well as tendinopathy, dactylitis, and swollen hand and foot syndrome. These manifestations were significantly associated with leprosy reactions and multibacillary disease. In conclusion, rheumatic manifestations were present in 87% of HD patients, with several being significantly more frequent than in controls. Moreover, a substantial proportion of patients continued to experience persistent rheumatic manifestations despite receiving or completing MDT. Given their potential to substantially impair functional status, these manifestations should be recognized early to ensure timely and appropriate management.<\/jats:p>","DOI":"10.4269\/ajtmh.25-0662","type":"journal-article","created":{"date-parts":[[2026,2,24]],"date-time":"2026-02-24T15:36:30Z","timestamp":1771947390000},"page":"624-628","source":"Crossref","is-referenced-by-count":0,"title":["Characterization of Rheumatic Manifestations in Hansen\u2019s Disease: A Standardized Approach among Patients from Puerto Rico"],"prefix":"10.4269","volume":"114","author":[{"given":"Luis M.","family":"Vil\u00e1","sequence":"first","affiliation":[{"name":"Division of Rheumatology, University of Puerto Rico Medical Sciences Campus, San Juan, Puerto Rico;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Pedro D.","family":"Gil de Rubio Cruz","sequence":"additional","affiliation":[{"name":"Section of General Internal Medicine, University of Puerto Rico Medical Sciences Campus, San Juan, Puerto Rico;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andrea B.","family":"Lastra-Annexy","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, San Juan VA Medical Center, San Juan, Puerto Rico;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Naydi","family":"Perez-R\u00edos","sequence":"additional","affiliation":[{"name":"Alliance for Clinical & Translational Research, University of Puerto Rico Medical Sciences Campus, San Juan, Puerto Rico;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sonia M.","family":"Santos-Exp\u00f3sito","sequence":"additional","affiliation":[{"name":"Department of Dermatology, University of Puerto Rico Medical Sciences Campus, San Juan, Puerto Rico"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Natalia","family":"Pelet del Toro","sequence":"additional","affiliation":[{"name":"Department of Dermatology, University of Puerto Rico Medical Sciences Campus, San Juan, Puerto Rico"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Aida L.","family":"Quintero-Noriega","sequence":"additional","affiliation":[{"name":"Department of Dermatology, University of Puerto Rico Medical Sciences Campus, San Juan, Puerto Rico"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"2795","reference":[{"key":"b1","article-title":"Institutional Repository for Information Sharing Weekly Epidemiological Record.","year":"2024"},{"key":"b2","article-title":"National Hansen\u2019s Disease (Leprosy) Program.","year":"2025"},{"key":"b3","series-title":"Best Pract Res Clin Rheumatol","first-page":"102039","article-title":"Musculoskeletal manifestations in leprosy","volume":"39","author":"Cruz","year":"2025"},{"key":"b4","series-title":"J Cutan Med Surg","first-page":"26","article-title":"Delay in diagnosis: Indeterminate leprosy presenting with rheumatic manifestations","volume":"4","author":"Sadeghi","year":"2000"},{"key":"b5","series-title":"Int J Rheum Dis","first-page":"64","article-title":"Lest we forget Hansen\u2019s disease (leprosy): An unusual presentation with an acute onset of inflammatory polyarthritis and the rheumatology experience","volume":"12","author":"Sheetal","year":"2009"},{"key":"b6","series-title":"An Bras Dermatol","first-page":"389","article-title":"Lepromatous leprosy simulating rheumatoid arthritis \u2013 Report of a neglected disease","volume":"92","author":"Andrade","year":"2017"},{"key":"b7","series-title":"Am J Trop Med Hyg","first-page":"1316","article-title":"Case report: Leprosy osteoarticular alterations mimicking rheumatoid arthritis","volume":"102","author":"do Esp\u00edrito Santo","year":"2020"},{"key":"b8","series-title":"Clin Cosmet Investig Dermatol","first-page":"121","article-title":"Misdiagnosis of leprosy with severe reversal reaction as psoriatic arthritis: A case report and literature review","volume":"18","author":"Gunawan","year":"2025"},{"key":"b9","series-title":"Cureus","first-page":"e13451","article-title":"Chronic hand swelling and dactylitis in leprosy: A case report and review of the literature","volume":"13","author":"Gupta","year":"2021"},{"key":"b10","series-title":"J Rheumatol","first-page":"1020","article-title":"Enthesopathy in leprosy","volume":"23","author":"Carpintero-Ben\u00edtez","year":"1996"},{"key":"b11","series-title":"Int J Rheum Dis","first-page":"1035","article-title":"Leprae reaction resembling rheumatologic disease as presenting feature of leprosy","volume":"19","author":"Baharuddin","year":"2016"},{"key":"b12","series-title":"J Rheumatol","first-page":"111","article-title":"Articular inflammatory manifestations in patients with different forms of leprosy","volume":"25","author":"Cossermelli-Messina","year":"1998"},{"key":"b13","series-title":"Mod Rheumatol Case Rep","first-page":"rxae077","article-title":"Jaccoud\u2019s arthropathy secondary to leprosy","volume":"9","author":"Viana","year":"2025"},{"key":"b14","series-title":"BMC Infect Dis","first-page":"455","article-title":"Leprosy presenting as remitting seronegative symmetrical synovitis with pitting oedema syndrome \u2013 A case report","volume":"19","author":"Guerra","year":"2019"},{"key":"b15","series-title":"An Bras Dermatol","first-page":"323","article-title":"Arthritis and diagnosis of leprosy: A case report and review of the literature","volume":"89","author":"Fernandes","year":"2014"},{"key":"b16","series-title":"Lupus","first-page":"1095","article-title":"Multibacillary leprosy mimicking systemic lupus erythematosus: Case report and literature review","volume":"24","author":"Horta-Baas","year":"2015"},{"key":"b17","series-title":"Cureus","first-page":"e39527","article-title":"Leprosy, the great imitator of rheumatic diseases: A case study","volume":"15","author":"Youssef","year":"2023"},{"key":"b18","series-title":"J Dermatol","first-page":"343","article-title":"Case of lepromatous leprosy misdiagnosed as systemic sclerosis","volume":"41","author":"Lee","year":"2014"},{"key":"b19","series-title":"Case Rep Infect Dis","first-page":"7802423","article-title":"Leprosy with atypical skin lesions masquerading as relapsing polychondritis","volume":"2016","author":"Pruthi","year":"2016"},{"key":"b20","series-title":"J Clin Rheumatol","first-page":"210","article-title":"Lucio\u2019s phenomenon: Report of two cases and review of the literature","volume":"6","author":"Roverano","year":"2000"},{"key":"b21","series-title":"BMJ Case Rep","first-page":"e236796","article-title":"Leprosy mimicking rheumatoid vasculitis with scleromalacia perforans","volume":"13","author":"Manoj","year":"2020"},{"key":"b22","series-title":"Medicine (Baltimore)","first-page":"442","article-title":"The rheumatic manifestations of leprosy (Hansen disease)","volume":"59","author":"Albert","year":"1980"},{"key":"b23","series-title":"Indian J Lepr","first-page":"69","article-title":"Rheumatological manifestations of leprosy- An observational study in a tertiary care centre in north-western India","volume":"96","author":"Ketki Singh","year":"2024"},{"key":"b24","series-title":"Clin Rheumatol","first-page":"274","article-title":"The rheumatic manifestations of leprosy","volume":"10","author":"Paira","year":"1991"},{"key":"b25","series-title":"Clin Rheumatol","first-page":"79","article-title":"Leprosy-related joint involvement","volume":"28","author":"Pereira","year":"2009"},{"key":"b26","series-title":"Am J Trop Med Hyg","first-page":"1726","article-title":"Hansen\u2019s disease and rheumatoid arthritis crossover of clinical symptoms: A case series of 18 patients in the United States","volume":"97","author":"Labuda","year":"2017"},{"key":"b27","article-title":"Hansen\u2019s Disease Program Service Delivery Work Plan.","year":"2025"},{"key":"b28","series-title":"Indian J Rheumatol","first-page":"14","article-title":"Rheumatological manifestations of Hansen\u2019s disease","volume":"13","author":"Wakhlu","year":"2018"},{"key":"b29","series-title":"J Am Acad Dermatol","first-page":"795","article-title":"Recognizing and managing the immunologic reactions in leprosy","volume":"71","author":"Kamath","year":"2014"},{"key":"b30","series-title":"Clin Exp Immunol","first-page":"391","article-title":"Association of rheumatoid factor with complement activation in rheumatoid arthritis and other diseases","volume":"53","author":"Reyes","year":"1983"},{"key":"b31","series-title":"Rheumatol Int","first-page":"3531","article-title":"Anti-cyclic citrullinated peptide antibodies and rheumatoid factor sera titers in leprosy patients from Mexico","volume":"32","author":"Zavala-Cerna","year":"2012"},{"key":"b32","series-title":"Cad Saude Publica","first-page":"e00279421","article-title":"Self-reported clinical history of misdiagnosed leprosy cases in the State of Mato Grosso, Brazil, 2016\u20132019","volume":"39","author":"Neves","year":"2023"},{"key":"b33","series-title":"Medicine (Baltimore)","first-page":"e34714","article-title":"Analysis of misdiagnosed or delayed-diagnosed Leprosy bacillus infection from 1990 to 2020 with a prophet time series prediction in Hubei Province, China","volume":"102","author":"Chen","year":"2023"},{"key":"b34","series-title":"An Bras Dermatol","first-page":"23","article-title":"Biological agents: Investigation into leprosy and other infectious diseases before indication","volume":"88","author":"Ant\u00f4nio","year":"2013"},{"key":"b1","article-title":"Institutional Repository for Information Sharing Weekly Epidemiological Record.","year":"2024"},{"key":"b2","article-title":"National Hansen\u2019s Disease (Leprosy) Program.","year":"2025"},{"key":"b3","series-title":"Best Pract Res Clin Rheumatol","first-page":"102039","article-title":"Musculoskeletal manifestations in leprosy","volume":"39","author":"Cruz","year":"2025"},{"key":"b4","series-title":"J Cutan Med Surg","first-page":"26","article-title":"Delay in diagnosis: Indeterminate leprosy presenting with rheumatic manifestations","volume":"4","author":"Sadeghi","year":"2000"},{"key":"b5","series-title":"Int J Rheum Dis","first-page":"64","article-title":"Lest we forget Hansen\u2019s disease (leprosy): An unusual presentation with an acute onset of inflammatory polyarthritis and the rheumatology experience","volume":"12","author":"Sheetal","year":"2009"},{"key":"b6","series-title":"An Bras Dermatol","first-page":"389","article-title":"Lepromatous leprosy simulating rheumatoid arthritis \u2013 Report of a neglected disease","volume":"92","author":"Andrade","year":"2017"},{"key":"b7","series-title":"Am J Trop Med Hyg","first-page":"1316","article-title":"Case report: Leprosy osteoarticular alterations mimicking rheumatoid arthritis","volume":"102","author":"do Esp\u00edrito Santo","year":"2020"},{"key":"b8","series-title":"Clin Cosmet Investig Dermatol","first-page":"121","article-title":"Misdiagnosis of leprosy with severe reversal reaction as psoriatic arthritis: A case report and literature review","volume":"18","author":"Gunawan","year":"2025"},{"key":"b9","series-title":"Cureus","first-page":"e13451","article-title":"Chronic hand swelling and dactylitis in leprosy: A case report and review of the literature","volume":"13","author":"Gupta","year":"2021"},{"key":"b10","series-title":"J Rheumatol","first-page":"1020","article-title":"Enthesopathy in leprosy","volume":"23","author":"Carpintero-Ben\u00edtez","year":"1996"},{"key":"b11","series-title":"Int J Rheum Dis","first-page":"1035","article-title":"Leprae reaction resembling rheumatologic disease as presenting feature of leprosy","volume":"19","author":"Baharuddin","year":"2016"},{"key":"b12","series-title":"J Rheumatol","first-page":"111","article-title":"Articular inflammatory manifestations in patients with different forms of leprosy","volume":"25","author":"Cossermelli-Messina","year":"1998"},{"key":"b13","series-title":"Mod Rheumatol Case Rep","first-page":"rxae077","article-title":"Jaccoud\u2019s arthropathy secondary to leprosy","volume":"9","author":"Viana","year":"2025"},{"key":"b14","series-title":"BMC Infect Dis","first-page":"455","article-title":"Leprosy presenting as remitting seronegative symmetrical synovitis with pitting oedema syndrome \u2013 A case report","volume":"19","author":"Guerra","year":"2019"},{"key":"b15","series-title":"An Bras Dermatol","first-page":"323","article-title":"Arthritis and diagnosis of leprosy: A case report and review of the literature","volume":"89","author":"Fernandes","year":"2014"},{"key":"b16","series-title":"Lupus","first-page":"1095","article-title":"Multibacillary leprosy mimicking systemic lupus erythematosus: Case report and literature review","volume":"24","author":"Horta-Baas","year":"2015"},{"key":"b17","series-title":"Cureus","first-page":"e39527","article-title":"Leprosy, the great imitator of rheumatic diseases: A case study","volume":"15","author":"Youssef","year":"2023"},{"key":"b18","series-title":"J Dermatol","first-page":"343","article-title":"Case of lepromatous leprosy misdiagnosed as systemic sclerosis","volume":"41","author":"Lee","year":"2014"},{"key":"b19","series-title":"Case Rep Infect Dis","first-page":"7802423","article-title":"Leprosy with atypical skin lesions masquerading as relapsing polychondritis","volume":"2016","author":"Pruthi","year":"2016"},{"key":"b20","series-title":"J Clin Rheumatol","first-page":"210","article-title":"Lucio\u2019s phenomenon: Report of two cases and review of the literature","volume":"6","author":"Roverano","year":"2000"},{"key":"b21","series-title":"BMJ Case Rep","first-page":"e236796","article-title":"Leprosy mimicking rheumatoid vasculitis with scleromalacia perforans","volume":"13","author":"Manoj","year":"2020"},{"key":"b22","series-title":"Medicine (Baltimore)","first-page":"442","article-title":"The rheumatic manifestations of leprosy (Hansen disease)","volume":"59","author":"Albert","year":"1980"},{"key":"b23","series-title":"Indian J Lepr","first-page":"69","article-title":"Rheumatological manifestations of leprosy- An observational study in a tertiary care centre in north-western India","volume":"96","author":"Ketki Singh","year":"2024"},{"key":"b24","series-title":"Clin Rheumatol","first-page":"274","article-title":"The rheumatic manifestations of leprosy","volume":"10","author":"Paira","year":"1991"},{"key":"b25","series-title":"Clin Rheumatol","first-page":"79","article-title":"Leprosy-related joint involvement","volume":"28","author":"Pereira","year":"2009"},{"key":"b26","series-title":"Am J Trop Med Hyg","first-page":"1726","article-title":"Hansen\u2019s disease and rheumatoid arthritis crossover of clinical symptoms: A case series of 18 patients in the United States","volume":"97","author":"Labuda","year":"2017"},{"key":"b27","article-title":"Hansen\u2019s Disease Program Service Delivery Work Plan.","year":"2025"},{"key":"b28","series-title":"Indian J Rheumatol","first-page":"14","article-title":"Rheumatological manifestations of Hansen\u2019s disease","volume":"13","author":"Wakhlu","year":"2018"},{"key":"b29","series-title":"J Am Acad Dermatol","first-page":"795","article-title":"Recognizing and managing the immunologic reactions in leprosy","volume":"71","author":"Kamath","year":"2014"},{"key":"b30","series-title":"Clin Exp Immunol","first-page":"391","article-title":"Association of rheumatoid factor with complement activation in rheumatoid arthritis and other diseases","volume":"53","author":"Reyes","year":"1983"},{"key":"b31","series-title":"Rheumatol Int","first-page":"3531","article-title":"Anti-cyclic citrullinated peptide antibodies and rheumatoid factor sera titers in leprosy patients from Mexico","volume":"32","author":"Zavala-Cerna","year":"2012"},{"key":"b32","series-title":"Cad Saude Publica","first-page":"e00279421","article-title":"Self-reported clinical history of misdiagnosed leprosy cases in the State of Mato Grosso, Brazil, 2016\u20132019","volume":"39","author":"Neves","year":"2023"},{"key":"b33","series-title":"Medicine (Baltimore)","first-page":"e34714","article-title":"Analysis of misdiagnosed or delayed-diagnosed Leprosy bacillus infection from 1990 to 2020 with a prophet time series prediction in Hubei Province, China","volume":"102","author":"Chen","year":"2023"},{"key":"b34","series-title":"An Bras Dermatol","first-page":"23","article-title":"Biological agents: Investigation into leprosy and other infectious diseases before indication","volume":"88","author":"Ant\u00f4nio","year":"2013"}],"container-title":["The American Journal of Tropical Medicine and 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