PARASITIC ARTHRITIS AND PARASITIC RHEUMATISM

Parasitic arthritis is a rare, although probably underdiagnosed, condition. A wide variety of parasites can cause arthritis. The parasites can invade the joint, either from adjacent bony or soft tissue structures or via the bloodstream. Similar to other infectious agents, parasites can also cause reactive arthritis (parasitic rheumatism). Clinical features vary widely. The clinical presentation is not specific to a given parasite but is influenced by host-related factors, including genetic factors. Diagnosis rests on precise criteria, of which the most important is the inefficacy of drugs usually given in rheumatic diseases, especially nonsteroidal antiinflammatory drugs, contrasting with the dramatic efficacy of specific anti-parasite agents. The pathogenesis of parasitic rheumatism remains obscure. It is important that physicians be familiar with parasitic rheumatism, since this inflammatory disease resolves promptly and completely under appropriate treatment. In contrast, failure to establish the diagnosis can lead to inappropriate treatments, in particular to systemic corticosteroid therapy whose effects can be devastating in patients with strongyloidiasis.