CASE 116 Hema N. Choudur, Anthony G. Ryan, and Peter L. Munk 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 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. Jaccoud’s nonerosive arthropathy. Figure 116D Figure 116E Figure 116F 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.
Jaccoud’s Arthropathy
Clinical Presentation
Radiologic Findings
Diagnosis
Differential Diagnosis
Discussion
Background
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