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chronic postrheumatic arthropathy (Jaccoud's arthropathy)

Etiology: - systemic lupus erythematosus (most common) [4] - 1st described in patients with rheumatic fever [4] - other diffuse connective tissue disease - scleroderma - mixed connective tissue disease - Sjogren's syndrome Epidemiology: - 5% of patients with systemic lupus erythematosus [4] Pathology: - persistent periarticular inflammation affecting structural integrity of joint capsule & supporting ligaments [4] - laxity of ligaments, fibrosis of the capsule, & muscular imbalance, rather than from destruction of the bone of joints [3] Clinical manifestations: - joint deformities are primarily in the hands - reducible subluxation of the digits [4] - muscle atrophy - severe ulnar deviation & flexion at the metacarpal-phalangeal joints - swan neck deformity [3,4] - Z deformity of the thumb [3] (case report) - resembles rheumatoid arthritis, but with less inflammation Laboratory: - rheumatoid factor is negative - anti-CCP Ab is negative [3] (case report) Radiology: - radiographs shows no erosions [4] - MRI of hand shows no erosions [3] (case report) Management: - physical therapy & the use of orthotic devices [3] - poorly responsive to DMARDS [3] - response to biologic response modifiers is unknown - soft-tissue surgery for the correction of the hand deformities [3]

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arthritis

References

  1. Grahame R et al Chronic post-rheumatic fever (Jaccoud's) arthropathy. Ann Rheum Dis. 1970 November; 29(6): 622-625. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1010593/
  2. Emrich L Chronic Post-Rheumatic Polyarthrosis: What is Jaccoud's Arthropathy? http://www.healthcentral.com/rheumatoid-arthritis/c/72218/138460/post
  3. Santiago M, Machicado V Jaccoud's arthropathy. (image, video) N Engl J Med 2015; 373:e1. July 2, 2015 PMID: 26132963 http://www.nejm.org/doi/full/10.1056/NEJMicm1410743
  4. Skare TL, Godoi Ade L, Ferreira VO. Jaccoud arthropathy in systemic lupus erythematosus: clinical and serological findings. Rev Assoc Med Bras. 2012 Jul-Aug;58(4):489-92 PMID: 22930030