Deforming arthropathy or lupus and rhupus hands in systemic lupus erythematosus

Jaccoud's arthropathy (JA) is a clinical situation nowadays present mostly in systemic lupus erythematosus (SLE). It is characterized by the presence of joint deformities such as "swan neck," ulnar deviation and "Z-thumb" resembling rheumatoid arthritis (RA) but that are passively correctable and without bone erosion on plain radiographs. From our cohort of SLE patients with JA, we selected a subgroup with a more severe form of this arthropathy and looked at their clinical and laboratory profile as well as studied the magnetic resonance imaging (MRI) findings or ultrasound (US) obtained from the hand with most evident deformities. Seven SLE patients with a severe form of JA were identified. All seven patients have "swan neck," ulnar deviation and "Z-thumb" deformities. Two out of seven had "mutilans-type JA" and four had fixed deformities in the metacarpophalangeal (MCP) joints. The MRI of the hand with more evident deformity clinically performed in six cases and US performed in one case showed mild synovitis in five and moderate synovitis in two patients, mild flexor tenosynovitis in six and severe tenosynovitis in one. Only two small bone erosions were observed in the second and third MCP joints of one patient with moderate synovitis. Severe JA compromises the functional capacity of the joints and imposes the risk of misdiagnosis of RA. With the improvement of the survival rate of SLE and the lack of specific prophylactic or therapeutical measures for JA, it is reasonable to assume that more and more cases of severe JA are going to be identified.

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“…Only two small bone erosions were observed in the second and third MCP joints of one patient with moderate synovitis. [3].…”

Section: Introductionmentioning

confidence: 95%

Severe Jaccoud’s arthropathy in systemic lupus erythematosus

et al. 2015

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“…They are self-limited and generally respond well to corticosteroids. Erosive arthritis occurs in 1.6% of SLE patients [3], but severe erosive joint involvement requiring surgical intervention is very rare [4]. It is often difficult to distinguish erosive arthritis in SLE, overlap of SLE and RA, and coexistence of SLE and RA.…”

Section: Introductionmentioning

confidence: 99%

Generalized laxity of connective tissue as a possible syndrome in systemic lupus erythematosus

2010

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We report a case of systemic lupus erythematosus (SLE) with Jaccoud's arthropathy, presenting atlantoaxial subluxation and multiple joint hypermobility. Radiological studies showed degenerative changes, but no destructive changes like rheumatoid arthritis (RA) were observed. Since these are rare complications of SLE, the coexistence of these complications suggests that they have a common pathogenesis. Generalized laxity of connective tissues may be a novel syndrome in SLE.

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“…Many cases start with symptoms from joints, most commonly the small joints of the hand (3). Symptoms from hands can vary considerably, from arthralgia to severely deformed fingers (3,4). Jaccoud's deformities in hands with SLE look similar to deformities in the rheumatoid hand, e.g., subluxation of the metacarpophalangeal (MCP) joints, swan-neck deformity, and ulnar deviation, but are due to changes in tendons and other soft tissues, while radiographs of the hand are mostly normal (2,5).…”

Section: Introductionmentioning

confidence: 99%

Hand function and performance of daily activities in systemic lupus erythematosus

Johnsson¹,

Sandqvist²,

Bengtsson³

et al. 2008

Arthritis & Rheumatism

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Objective. To investigate hand problems in patients with systemic lupus erythematosus (SLE) and to explore consequences on the ability to perform daily activities. Methods. One hundred nine patients with SLE completed a questionnaire assessing hand problems in terms of deficits in body structures, e.g., joints, and body functions including pain, grip force, and other physiologic functions of the hand, the Health Assessment Questionnaire (HAQ), and the Simple hand test. Patients who stated problems in hand function answered questions about performance of daily activities and to what extent different deficits in body structures and body functions interfered. Results. Seventy-three percent of patients experienced hand problems and 42% reported interference with performance of daily activities. Problems from body structures of the hand were distributed relatively evenly over joints and tendons/muscles. Reduced grip force and activity-induced pain were the most commonly reported problems in body functions. The most affected activity area was productivity, namely household tasks, work at home, work/study, and child care; least affected was self-care. Reduced grip force followed by fumbling and pain were the most frequently reported body functions to create difficulties in performing daily activities. When comparing patients with and without difficulties in performing daily activities, there were significant differences in problems from tendons/muscles, joints in the thumb, reduced force, stiffness, fumbling, numbness/tingling, and the HAQ. Conclusion. A majority of the study group had hand problems and almost half of the group experienced difficulties in performing daily activities due to SLE. The most affected activity area was productivity, where reduced grip force, fumbling, and pain were the most interfering body functions.

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Deforming arthropathy or lupus and rhupus hands in systemic lupus erythematosus

Cited by 151 publications

References 6 publications

Severe Jaccoud’s arthropathy in systemic lupus erythematosus

Severe Jaccoud’s arthropathy in systemic lupus erythematosus

Generalized laxity of connective tissue as a possible syndrome in systemic lupus erythematosus

Hand function and performance of daily activities in systemic lupus erythematosus

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