Jaccoud’s Arthropathy
Hema N. Choudur, Anthony G. Ryan, and Peter L. Munk
Clinical Presentation
As a child, the young woman in this case suffered from an attack of rheumatic fever. Subsequently, she developed mitral stenosis and had a mitral valve replacement. She also developed progressive painless deformity of the hands and feet. On clinical examination, the deformities were reducible with mild compressive pressure on a flat surface. No associated tenderness was elicited.
Figure 116A
Figure 116B
Radiologic Findings
Radiographs of the hands and feet (Figs. 116A–116F) demonstrate a nonerosive arthropathy of both hands, seen as flexion deformities of the metacarpophalangeal joints with associated ulnar deviation. Hyperextension of the second to fifth proximal interphalangeal joints with flexion deformity of the second and fifth distal interphalangeal joints is also present. No erosions, periarticular osteopenia, or soft-tissue swelling is evident. Similar findings are present in the feet.
Diagnosis
Jaccoud’s nonerosive arthropathy.
Figure 116D
Figure 116E
Figure 116F
Differential Diagnosis
On clinical examination, this characteristic deformity may be found in the collagen vascular diseases, especially systemic lupus erythematosus (SLE).
It is very rare that similar radiologic findings may be seen in rheumatoid arthritis, ankylosing spondylitis, or Ehlers-Danlos syndrome.
Discussion
Background
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