What is Jaccoud's arthrosis? Joint pain in people with lupus may not be a "accompanying symptom" case sharing

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Jaccoud's arthropathy (JA) is a non-erosive, reducible osteoarticular lesion first described
by Jaccoud in 1866 in a case of rheumatic fever.
In addition to rheumatic fever, it is now commonly reported that it is secondary to systemic lupus erythematosus (SLE), and a very small number of patients are secondary to Sjogren's syndrome (SS), psoriatic arthritis, gout and other diseases
.
The incidence of JA is low and the clinical presentation is highly similar to rheumatoid arthritis, so it may be clinically ^{misdiagnosed1}
.

JA-lesions are mainly abnormalities of joint appendages, usually without obvious bone destruction
.
However, a few studies have found that some patients with JA may have mild synovitis and bone ^erosion1
.
This article will introduce a case
of systemic lupus erythematosus complicated with JA without bone erosion reported by Director Lin Changsong and Dr.
Xu Qiang (corresponding author) of the First Affiliated Hospital of Guangzhou University of Chinese Medicine.

Case Profile

A 27-year-old woman presents to hospital for 2 years with hand and foot pain, swelling and progressive deformity
.
He was diagnosed with systemic lupus erythematosus and lupus V nephritis
5 years ago.
Examination showed that her erythrocyte sedimentation rate and C-reactive protein levels were elevated; Antinuclear antibody, anti-dsDNA antibody, anti-extractable nuclear antigen antibody were positive, complement C3 and C4 were reduced, and no bone erosion was shown on X-ray and magnetic resonance examination (Figure 1).

Figure 1 Patient's hand and foot manifestations

In this case, the patient has a history of SLE and is accompanied by deformities
of the hands and feet.
X-rays showing joint dislocation without bone erosion are consistent with the diagnosis of JA, hence the diagnosis of JA
.
Oral prednisone (10 mg/day), tofacitinib (5 mg twice daily [bid]), methotrexate (10 mg/week), and celecoxib (0.
2 g, bid) were given
.
The treated patients had improved their joint symptoms and did not progress
during the 4-month follow-up period.
The specific clinical manifestations and treatment process are shown in Figure 2
.

Figure 2 Specific clinical manifestations and treatment schedule

Case discussion

JA occurs in 5% of patients with SLE and rheumatic fever, and only cases have been reported
in SS.
The main clinical manifestations of JA are reducible joint deformity, mostly involving the joints of both hands, and a small number of patients can involve both feet, typical deformities are ulnar deviation and subluxation of the metacarpophalangeal joint, hyperextension of the thumb and proximal interphalangeal joint, thumb Z-deformity, similar to typical advanced rheumatoid arthritis joint deformity, such as swan neck and button pattern ^changes1
.
In this case, the patient had SLE and JA, and although some patients with SLE may have joint symptoms, there are still some symptoms that cannot be explained by SLE
.
In this regard, the researchers believe that it is necessary to distinguish joint deformity with SLE from simple joint ^symptoms2
.

There are currently no widely accepted diagnostic criteria
for JA.
The diagnostic criteria proposed by Santiago in 2013 are as follows: (1) There are typical joint deformities, such as swan neck deformity and thumb subluxation, button pattern deformity and hallux valgus
.
(2) The affected joint has arthritis or has had arthritis in the past
.
(3) Healthy family members do not have similar joint deformities
.
(4) Regardless of whether there are bone erosion-like changes on joint MRI or ultrasound, there are no bone-erosion-like changes
on plain X-rays.
Diagnosis is made if the above 4 items are ^met1
.

The pathogenesis of JA combined with SLE is unclear, and there is no specific ^treatment2
.
In this case, anti-inflammatory drugs, hormones, methotrexate, and antimalarials, and white peony total glycoside (0.
6 g orally twice daily) was used for early treatment, and was the first to use Janus kinase inhibitors for the treatment of JA
.
Patients have been given mycophenolate mofetil, azathioprine, hydroxychloroquine, cyclosporine A, and leflunomide, and joint symptoms continue to reliev.

After treatment with tofacitinib, methotrexate, and celecoxib in combination with prednisone, the progression of joint symptoms slowed, joint pain and edema decreased, and decreased
levels of D-dimer were observed.
Tofacitinib, methotrexate, and celecoxib in combination with prednisone may be effective treatments
for JA.
Admittedly, this conclusion still needs to be validated
by long-term follow-up studies.

Clinically, joint pain in SLE patients is often seen as a concomitant symptom
.
In the treatment of the primary disease, the patient's joint symptoms may be overlooked
.
However, when the "arthralgia" is actually JA or rhupus syndrome (rheumatoid arthritis and SLE overlap syndrome), this can lead to impaired
joint function.
Therefore, regular joint examination of patients with SLE with joint symptoms is recommended, and increased attention
to SLE combined with erosive and non-erosive arthritis is recommended.

References:

1.
PEI Biwei,XIE Xiangliang,KE Liping.
Clinical report and literature review of Jaccoud's arthropathy misdiagnosed as rheumatoid arthritis[J].
Clinical Misdiagnosis and Mistreatment,2018,31(5):32-35.
DOI:10.
3969/j.
issn.
1002-3429.
2018.
05.
009.

2.
Chen SL, Zheng HJ, Zhang LY, Xu Q, Lin CS.
Case report: Joint deformity associated with systemic lupus erythematosus.
Immun Inflamm Dis.
2022 Oct; 10(10):e717.
doi: 10.
1002/iid3.
717.
PMID: 36169251.