Pattern of enthesopathy in bilharzial arthropathy

الملخص EN

Objective: To study the pattern of enthesopathy in patients who had bilharzial arthropathy, clinically, radiologically, histopathologically as well as immuno-protein deposition with immunofluorescence technique.

Design: Prospective.

Setting: Al-Hussein Outpatient Clinics of the Rheumatology & Rehabilitation, Tropical Medicine and Urology Departments of Al-Azhar Faculty of Medicine and Tudor Bilharz Institute (Imbaba).

Patients: Eighty patients who had schistosomiasis (haematobium or mansoni, 40 patients with each) and developed reactive arthropathy secondary to this infestation, twenty patients infested with bilharziasis without arthropathy.

Intervention: All patients were subjected to: standard questionnaire, clinical evaluation, radiological examination and laboratory investigations (urine and stool analysis and culture, liver and kidney functions, rheumatoid factor, serum uric acid, synovial fluid analysis) and lastly biopsies from susceptible patients (enthesis and synovium) for histopathological study and immunofluorescence study.

Results: Enthesopathy and arthropathy of the lower limbs is the prominent clinical feature.

Immuno-protein (immune-complex) deposition was detected in 60% of cases.

Granular interstitial and perivascular immuno-protein deposition was detected in 60% of synovial and enthesis biopsies.

All collected synovial fluid samples showed specific anti-bilharzial antibodies with different titers.

Conclusion: Lower limb enthesopathy and arthropathy is a prominent clinical feature of bilharzial arthropathy and the presence of immuno-protein and specific antibilharzial antibodies in synovial fluid and tissues are highly suggestive of the immuno-mediated role in the pathogenesis of bilharzial arthropathy.