Original articleMagnetic resonance imaging of Jaccoud's arthropathy in systemic lupus erythematosus☆
Introduction
The arthropathy deforming, but not erosive, seen initially in patients with rheumatic fever (RF) with frequent episodes of arthritis has been known in medical literature as “Jaccoud's arthropathy” (JA), from the classical description of Jaccoud in 1869 [1], [2]. Although initially described in RF [3], this complication has been described in many other conditions [4], particularly systemic lupus erythematosus (SLE) [5]. In the latter illness, JA has been observed to have a prevalence of around 5% [6].
JA is described as a non-erosive deformity with subluxations, usually of the metacarpophalangeal (MCP) joints, ulnar deviation along with swan-neck, and “Z” thumb deformities, which are reducible by the physician or the patient. Although mainly affecting the hands, it has also been observed in other joints, such as feet [7], knee [8], [9], and shoulder [10]. It has been regarded as a consequence of chronic inflammation causing peri-articular swelling and fibrosis with ligament laxity combined with muscle imbalance, rather than the destructive effect of synovitis as in rheumatoid arthritis (RA).
In recent years, magnetic resonance imaging (MRI) has been accepted as an excellent technique for three-dimensional imaging of joint pathology and soft tissue in rheumatic diseases [11], [12], [13], [14], [15], [16], [17], [18], having a clear advantage over the other imaging modalities, such as conventional radiography. Although there have been many studies showing the benefits of the MRI in the evaluation of RA, little has been described in SLE arthropathy. The purpose of this study was to perform a detailed MRI analysis of changes in the joints of the hands in patients with JA secondary to SLE.
Section snippets
Population
Patients diagnosed with SLE based on the American College of Rheumatology criteria [19] and JA who attended the Rheumatology Service of Hospital Santa Izabel in Salvador, Brazil, were included in the present study. The definition of JA was based on the clinical criteria (reversible joint deformities), and on the absence of bone erosion in conventional postero-anterior radiograph, according to the criteria proposed by Kahn [20]. The clinical features of these patients have been published earlier
Results
Twenty patients (19 women and one man; median age 44.7 years; range 20–76 years) with different disease duration (median 14.7 years; range 5–26 years) and arthritis duration (median 13.7 years; range 4–26 years) with JA were included in the study.
A total of 300 joints were studied. In one patient, the contrast was not used because of history of renal failure and dialysis therapy. In two patients, the CM joints could not be assessed because of the asymmetry between the size of the coil used and
Discussion
Articular and peri-articular alterations are the most common symptoms present in SLE, and 90% of patients with SLE will experience articular symptoms at some point in the course of the illness [26]. Bywaters was the first to point out the similarity between the deforming arthropathy of SLE and that originally described in 1869 by Jaccoud for recurrent RF, reporting a prevalence of 5% [27]. The relationship between arthritis and SLE was established as a diagnostic feature of this pathology only
Conflict of interest statement
The authors have no conflict of interest to declare.
Acknowledgements
M.S. is currently receiving a scholarship from Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq) and FIDEPS. The authors thank Professor Artur Fernandes for the excellent suggestions provided during the elaboration of the manuscript. We extend our acknowledgements to the DASA Group that gave support for the development of this project.
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2015, Autoimmunity ReviewsCitation Excerpt :The MRI pattern of arthritis in SLE was previously studied by Ostendorf et al. and Sà Ribeiro et al. in two small uncontrolled series (14 and 20 patients, respectively) of patients with SLE and arthritis. Despite differences in imaging protocol and definitions, they found a prevalence of bone erosions of 50–57% with a significant advantage in sensitivity with respect to conventional radiology [17,18] In 2005, Boutry et al. compared MRI findings of 14 SLE patients with inflammatory arthralgias with 26 early-RA patients and they did not find any differences in term of erosion scores between the groups [19]. In view of these MRI findings, this work adds information to the existing literature on the study of joint involvement in SLE for a number of reasons.
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This article is part of Daniel Sá Ribeiro MSc thesis to be presented at EBMSP.