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*It is only for medical professionals to read for reference.
Jaccoud arthropathy is very similar to the hand joint deformities of rheumatoid arthritis, so it is easy to cause misdiagnosis.
Jaccoud arthropathy is an arthropathy with multiple joint subluxation deformities.
The articular surface often lacks evidence of erosion or erosion, and usually does not affect joint function.
So, which diseases are Jaccoud joint disease related to? What are the clinical features of this joint disease? What diseases is Jaccoud joint disease related to? Jaccoud joint disease was first reported by François-Sigismond Jaccoud in 1869.
Early related reports were more common in patients with rheumatic fever and recurrent arthritis.
Jaccoud arthropathy is seen in about 4.
2% of patients with rheumatic fever [1].
In 2013, Chaurasia AS et al.
reported a case of a 20-year-old man with exertional dyspnea for 1 year in The Lancet[2].
When the patient was 9 years old, he had 2 times of migratory polyarthritis, suggesting rheumatic fever.
During the consultation, the doctor found that the patient had deformities and swelling of the hand-foot joints, flexion of the metacarpophalangeal joints 2-5 of the hands, flexion of the distal interphalangeal joints, hyperextension of the proximal interphalangeal joints, but no functional limitations and subcutaneous nodules.
The patient is asymptomatic and the deformity can be self-corrected (reversible).
X-ray examination of the hand showed no active inflammation of the articular surface.
Therefore, the patient is completely unaware of his joint deformities.
Figure 1: A 20-year-old man with a history of rheumatic fever: finger joint deformity, hand X-ray examination showed no articular surface inflammation [2] Heart examination revealed a 3/6 grade systolic murmur at the apex.
The erythrocyte sedimentation rate was 68 mm/h, and the C-reactive protein was 120 mg/L.
Streptolysin "O", rheumatoid factor, anti-nuclear antibody and anti-cyclic citrullinated peptide (CCP) antibody were all negative.
Upon examination, the doctor found that the patient still had moderate pulmonary hypertension and the left ventricle diameter was normal.
The final diagnosis was Jaccoud arthropathy.
As the prevalence of rheumatic fever has decreased in recent years, most of the current cases of Jaccoud joint disease are related to systemic lupus erythematosus.
Approximately 5% of patients with systemic lupus erythematosus can be accompanied by Jaccoud joint disease [1].
In 2015, the New England Journal of Medicine also reported a case of a 58-year-old male taxi driver with a 15-year history of systemic lupus erythematosus[3].
His autoimmune antibodies suggested anti-nuclear antibodies, anti-ds-DNA antibodies, and anti-Ro (SS -A) Antibody is positive, rheumatoid factor and anti-CCP antibody are negative.
Although treated with glucocorticoids, hydroxychloroquine and azathioprine, there are still finger deformities such as swan neck deformity, thumb "Z" deformity and little finger ulnar deviation in the course of 10 years, and these deformities are reversible, hand MRI It suggests that there is no articular surface erosion, which is in line with Jaccoud arthropathy.
Figure 2: A 58-year-old man with a history of systemic lupus erythematosus: finger joint deformity, hand MRI showed no articular surface erosion [3] Other systemic diseases that can be accompanied by Jaccoud arthropathy include Sjogren’s syndrome, scleroderma, Dermatomyositis, psoriatic arthritis, vasculitis, ankylosing spondylitis, mixed conjunctival tissue disease, pyoderma gangrenosum, sarcoidosis, inflammatory bowel disease and other autoimmune diseases [4].
It is worth noting that Jaccoud arthropathy may also be related to infection (HIV infection, fungal disease, Borrelia disease), joint hypermobility syndrome, tumor, chronic lung disease, Caroli disease and other diseases [1,4].
What are the clinical features of Jaccoud arthropathy? It can be seen from the above cases that the typical clinical manifestations of Jaccoud arthropathy mainly include swan neck deformity, button flower deformity, thumb "Z" deformity and other joint deformities similar to rheumatoid arthritis, but the joint deformities of Jaccoud arthritis can be Self-correcting or reversible, and there is usually no joint erosion in X-ray examination.
The deformity of Jaccoud arthropathy is mainly related to soft tissue abnormalities such as ligament laxity, joint capsule fibrosis and muscle imbalance, rather than joint destruction similar to rheumatoid arthritis [3].
However, new imaging techniques such as joint MRI and high-performance ultrasound have also revealed that a small number of patients with Jaccoud arthropathy have small erosions on the articular surface [1].
Figure 3: A typical Jaccoud arthropathy deformity (A, B) and reversibility (C, D) in a patient with systemic lupus erythematosus [1] Jaccoud arthropathy mainly occurs in the hands, but can also be seen in the feet and knees And other joints such as the shoulder.
Jaccoud arthropathy can cause painful symptoms, it can also be painless, and it can even develop without any history of arthritis.
Jaccoud arthropathy usually has no functional limitation, but a small number of advanced patients may suffer from joint contracture caused by local residual fibrosis, which may cause functional limitation and affect the quality of life.
A Brazilian study showed that 21 out of 606 patients with systemic lupus erythematosus had Jaccoud joint disease, with a prevalence of 3.
47%.
Among them, there were 20 female patients, with an average age of 40.
2 ± 8.
8 years (24-55 years).
Compared with patients with systemic lupus erythematosus without Jaccoud arthropathy, there is no significant difference in clinical or laboratory characteristics of patients with Jaccoud arthropathy [4].
A Japanese retrospective analysis of 340 patients with systemic lupus erythematosus showed that among 15 patients with Jaccoud arthropathy (4.
4%), the average age (51.
26 years) at the time of diagnosis of systemic lupus erythematosus was significantly higher than that of the control group ( 29.
6 years old).
Of the 11 patients with Jaccoud arthropathy who underwent related examinations, 10 (91%) were diagnosed with Sjogren’s syndrome.
Therefore, patients with systemic lupus erythematosus complicated by Jaccoud arthropathy are older and have a higher proportion of Sjogren’s syndrome [5].
In addition, some studies have shown that patients with Jaccoud arthropathy may be more common in patients with long arthritis, rheumatoid factor-positive, high C-reactive protein levels, and anti-U1-RNP antibodies.
However, the sample size of these studies is small, and different studies may reach inconsistent conclusions, and more research evidence is needed to support [1].
Summary In summary, Jaccoud arthropathy is a kind of joint disease dominated by hand deformities such as swan neck deformity, button flower deformity, and thumb "Z" deformity.
Jaccoud arthropathy is mainly seen in rheumatic immune diseases such as systemic lupus erythematosus and rheumatic fever, and the risk of patients with Sjogren’s syndrome is higher.
Jaccoud arthropathy is very similar to the hand joint deformity of rheumatoid arthritis, so it is easy to cause misdiagnosis.
The most important clinical feature and distinguishing point of Jaccoud arthropathy is that the joint deformity of the disease is reversible, and the X-ray examination usually has no erosion.
The treatment of Jaccoud arthropathy mainly includes physical therapy, muscle strengthening and the use of orthopedic devices, and the treatment of related diseases such as systemic lupus erythematosus and rheumatic fever.
The therapeutic effects of glucocorticoids and immunosuppressants are not exact, and we look forward to more strong research evidence to support them in the near future.
References: [1]Santiago MB.
Miscellaneous non-inflammatory musculoskeletal conditions.
Jaccoud's arthropathy.
Best Pract Res Clin Rheumatol.
2011 Oct;25(5):715-25.
doi: 10.
1016/j.
berh.
2011.
10.
018.
PMID : 22142749.
[2] Chaurasia AS, Nawale JM, Patil SN, Yemul MA, Mukhedkar SM, Singh D, Patil PK, Chavan RV.
Jaccoud's arthropathy.
Lancet.
2013 Jun 15;381(9883):2108.
doi: 10.
1016/ S0140-6736(12)61681-X.
Epub 2013 Jan 4.
PMID: 23290493.
[3] Santiago M, Machicado V.
Jaccoud's Arthropathy.
N Engl J Med.
2015 Jul 2;373(1):e1.
doi: 10.
1056 /NEJMicm1410743.
PMID: 26132963.
[4] Santiago MB, Galvão V.
Jaccoud arthropathy in systemic lupus erythematosus: analysis of clinical characteristics and review of the literature.
Medicine (Baltimore).
2008 Jan;87(1):37-44.
doi: 10.
1097/MD.
0b013e3181632d18.
PMID: 18204369.
[5] Takeishi M, Mimori A, Suzuki T.
Clinical and immunological features of systemic lupus erythematosus complicated by Jaccoud's arthropathy.
Mod Rheumatol.
2001 Mar;11(1):47-51.
doi: 10.
3109/s101650170043.
PMID: 24387020.
Jaccoud arthropathy is very similar to the hand joint deformities of rheumatoid arthritis, so it is easy to cause misdiagnosis.
Jaccoud arthropathy is an arthropathy with multiple joint subluxation deformities.
The articular surface often lacks evidence of erosion or erosion, and usually does not affect joint function.
So, which diseases are Jaccoud joint disease related to? What are the clinical features of this joint disease? What diseases is Jaccoud joint disease related to? Jaccoud joint disease was first reported by François-Sigismond Jaccoud in 1869.
Early related reports were more common in patients with rheumatic fever and recurrent arthritis.
Jaccoud arthropathy is seen in about 4.
2% of patients with rheumatic fever [1].
In 2013, Chaurasia AS et al.
reported a case of a 20-year-old man with exertional dyspnea for 1 year in The Lancet[2].
When the patient was 9 years old, he had 2 times of migratory polyarthritis, suggesting rheumatic fever.
During the consultation, the doctor found that the patient had deformities and swelling of the hand-foot joints, flexion of the metacarpophalangeal joints 2-5 of the hands, flexion of the distal interphalangeal joints, hyperextension of the proximal interphalangeal joints, but no functional limitations and subcutaneous nodules.
The patient is asymptomatic and the deformity can be self-corrected (reversible).
X-ray examination of the hand showed no active inflammation of the articular surface.
Therefore, the patient is completely unaware of his joint deformities.
Figure 1: A 20-year-old man with a history of rheumatic fever: finger joint deformity, hand X-ray examination showed no articular surface inflammation [2] Heart examination revealed a 3/6 grade systolic murmur at the apex.
The erythrocyte sedimentation rate was 68 mm/h, and the C-reactive protein was 120 mg/L.
Streptolysin "O", rheumatoid factor, anti-nuclear antibody and anti-cyclic citrullinated peptide (CCP) antibody were all negative.
Upon examination, the doctor found that the patient still had moderate pulmonary hypertension and the left ventricle diameter was normal.
The final diagnosis was Jaccoud arthropathy.
As the prevalence of rheumatic fever has decreased in recent years, most of the current cases of Jaccoud joint disease are related to systemic lupus erythematosus.
Approximately 5% of patients with systemic lupus erythematosus can be accompanied by Jaccoud joint disease [1].
In 2015, the New England Journal of Medicine also reported a case of a 58-year-old male taxi driver with a 15-year history of systemic lupus erythematosus[3].
His autoimmune antibodies suggested anti-nuclear antibodies, anti-ds-DNA antibodies, and anti-Ro (SS -A) Antibody is positive, rheumatoid factor and anti-CCP antibody are negative.
Although treated with glucocorticoids, hydroxychloroquine and azathioprine, there are still finger deformities such as swan neck deformity, thumb "Z" deformity and little finger ulnar deviation in the course of 10 years, and these deformities are reversible, hand MRI It suggests that there is no articular surface erosion, which is in line with Jaccoud arthropathy.
Figure 2: A 58-year-old man with a history of systemic lupus erythematosus: finger joint deformity, hand MRI showed no articular surface erosion [3] Other systemic diseases that can be accompanied by Jaccoud arthropathy include Sjogren’s syndrome, scleroderma, Dermatomyositis, psoriatic arthritis, vasculitis, ankylosing spondylitis, mixed conjunctival tissue disease, pyoderma gangrenosum, sarcoidosis, inflammatory bowel disease and other autoimmune diseases [4].
It is worth noting that Jaccoud arthropathy may also be related to infection (HIV infection, fungal disease, Borrelia disease), joint hypermobility syndrome, tumor, chronic lung disease, Caroli disease and other diseases [1,4].
What are the clinical features of Jaccoud arthropathy? It can be seen from the above cases that the typical clinical manifestations of Jaccoud arthropathy mainly include swan neck deformity, button flower deformity, thumb "Z" deformity and other joint deformities similar to rheumatoid arthritis, but the joint deformities of Jaccoud arthritis can be Self-correcting or reversible, and there is usually no joint erosion in X-ray examination.
The deformity of Jaccoud arthropathy is mainly related to soft tissue abnormalities such as ligament laxity, joint capsule fibrosis and muscle imbalance, rather than joint destruction similar to rheumatoid arthritis [3].
However, new imaging techniques such as joint MRI and high-performance ultrasound have also revealed that a small number of patients with Jaccoud arthropathy have small erosions on the articular surface [1].
Figure 3: A typical Jaccoud arthropathy deformity (A, B) and reversibility (C, D) in a patient with systemic lupus erythematosus [1] Jaccoud arthropathy mainly occurs in the hands, but can also be seen in the feet and knees And other joints such as the shoulder.
Jaccoud arthropathy can cause painful symptoms, it can also be painless, and it can even develop without any history of arthritis.
Jaccoud arthropathy usually has no functional limitation, but a small number of advanced patients may suffer from joint contracture caused by local residual fibrosis, which may cause functional limitation and affect the quality of life.
A Brazilian study showed that 21 out of 606 patients with systemic lupus erythematosus had Jaccoud joint disease, with a prevalence of 3.
47%.
Among them, there were 20 female patients, with an average age of 40.
2 ± 8.
8 years (24-55 years).
Compared with patients with systemic lupus erythematosus without Jaccoud arthropathy, there is no significant difference in clinical or laboratory characteristics of patients with Jaccoud arthropathy [4].
A Japanese retrospective analysis of 340 patients with systemic lupus erythematosus showed that among 15 patients with Jaccoud arthropathy (4.
4%), the average age (51.
26 years) at the time of diagnosis of systemic lupus erythematosus was significantly higher than that of the control group ( 29.
6 years old).
Of the 11 patients with Jaccoud arthropathy who underwent related examinations, 10 (91%) were diagnosed with Sjogren’s syndrome.
Therefore, patients with systemic lupus erythematosus complicated by Jaccoud arthropathy are older and have a higher proportion of Sjogren’s syndrome [5].
In addition, some studies have shown that patients with Jaccoud arthropathy may be more common in patients with long arthritis, rheumatoid factor-positive, high C-reactive protein levels, and anti-U1-RNP antibodies.
However, the sample size of these studies is small, and different studies may reach inconsistent conclusions, and more research evidence is needed to support [1].
Summary In summary, Jaccoud arthropathy is a kind of joint disease dominated by hand deformities such as swan neck deformity, button flower deformity, and thumb "Z" deformity.
Jaccoud arthropathy is mainly seen in rheumatic immune diseases such as systemic lupus erythematosus and rheumatic fever, and the risk of patients with Sjogren’s syndrome is higher.
Jaccoud arthropathy is very similar to the hand joint deformity of rheumatoid arthritis, so it is easy to cause misdiagnosis.
The most important clinical feature and distinguishing point of Jaccoud arthropathy is that the joint deformity of the disease is reversible, and the X-ray examination usually has no erosion.
The treatment of Jaccoud arthropathy mainly includes physical therapy, muscle strengthening and the use of orthopedic devices, and the treatment of related diseases such as systemic lupus erythematosus and rheumatic fever.
The therapeutic effects of glucocorticoids and immunosuppressants are not exact, and we look forward to more strong research evidence to support them in the near future.
References: [1]Santiago MB.
Miscellaneous non-inflammatory musculoskeletal conditions.
Jaccoud's arthropathy.
Best Pract Res Clin Rheumatol.
2011 Oct;25(5):715-25.
doi: 10.
1016/j.
berh.
2011.
10.
018.
PMID : 22142749.
[2] Chaurasia AS, Nawale JM, Patil SN, Yemul MA, Mukhedkar SM, Singh D, Patil PK, Chavan RV.
Jaccoud's arthropathy.
Lancet.
2013 Jun 15;381(9883):2108.
doi: 10.
1016/ S0140-6736(12)61681-X.
Epub 2013 Jan 4.
PMID: 23290493.
[3] Santiago M, Machicado V.
Jaccoud's Arthropathy.
N Engl J Med.
2015 Jul 2;373(1):e1.
doi: 10.
1056 /NEJMicm1410743.
PMID: 26132963.
[4] Santiago MB, Galvão V.
Jaccoud arthropathy in systemic lupus erythematosus: analysis of clinical characteristics and review of the literature.
Medicine (Baltimore).
2008 Jan;87(1):37-44.
doi: 10.
1097/MD.
0b013e3181632d18.
PMID: 18204369.
[5] Takeishi M, Mimori A, Suzuki T.
Clinical and immunological features of systemic lupus erythematosus complicated by Jaccoud's arthropathy.
Mod Rheumatol.
2001 Mar;11(1):47-51.
doi: 10.
3109/s101650170043.
PMID: 24387020.
