Elsevier

Joint Bone Spine

Volume 77, Issue 3, May 2010, Pages 241-245
Joint Bone Spine

Original article
Magnetic resonance imaging of Jaccoud's arthropathy in systemic lupus erythematosus

https://doi.org/10.1016/j.jbspin.2009.10.013Get rights and content

Abstract

Objective

To perform a detailed magnetic resonance imaging (MRI) analysis of the hands of patients with Jaccoud's arthropathy (JA) secondary to systemic lupus erythematosus (SLE).

Methods

The hand with more expressive deformities compatible with JA from a group of SLE patients was examined by 1.5-T MRI. The protocol included coronal, sagittal, and axial turbo-spin-echo images before and after the administration of contrast medium. The presence of synovitis, edema, erosion, cysts, and tenosynovitis in the carpometacarpal, metacarpophalangeal, and proximal interphalangeal joints were scored based on a modified Outcome Measures in Rheumatology recommendations.

Results

Twenty SLE patients, (19 women and one man) with median age of 44.7 years (range: 20–76 years), median disease duration of 14.7 years (range: 5–26 years), and median arthritis duration of 13.7 years (range: 4–26 years) were studied. Of the 300 joints evaluated, 202 (67.3%) had some degree of synovitis. Sixteen out of 300 examined joints (5.3%) small areas of erosion were seen in 10 out of the 20 patients (50%). Subchondral bone edema was found in eight out of the 20 (40%) patients or a total of 18 joints (6%). A total of 200 compartments tendons were evaluated, and changes were found in 77 (38.5%) of them. In four out of the 20 patients, the MRI revealed bone cysts.

Conclusions

The MRI seems to be a non-invasive diagnostic tool in patients with JA secondary to SLE, and may contribute to understanding the mechanism involved in the development of this deformity.

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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