Jaccoud's arthropathy in systemic lupus erythematosus: Differentiation of deforming and erosive patterns by magnetic resonance imaging

Abstract

Objective. To evaluate alterations of the soft tissues, tendons, and bones as detected by magnetic resonance imaging (MRI) in patients with systemic lupus erythematosus (SLE)-associated arthritis of the finger joints.Methods. Both hands of 14 patients with SLE of various activities and durations and with arthritis and/or deformities of the finger joints were examined by MRI and conventional radiography. Coronal T1-weighted spin-echo (with and without gadolinium contrast), axial T2-weighted turbo spin-echo, coronal fatsuppressed short tau inversion recovery, and 3-dimensional double-echo steady-state sequences were acquired and analyzed, and the findings were compared with those from conventional radiographs.Results. MRI detected periarticular capsular swelling in all 14 patients, joint effusion in 7, edematous tenosynovitis in 6, proliferative tenosynovitis (flexor and/or extensor tendons) in 4, and intraarticular signs of synovial membrane hypertrophy in 10 patients, 9 of whom showed enhancement after administration of contrast medium. Bony erosions were identified in 8 patients by MRI; conventional radiography missed these erosions in 2 of the 8 patients. Four of the 14 patients were designated as Jaccoud's arthropathy index-positive, and all 4 showed severe edematous tenosynovitis and capsular swelling, but no signs of bony erosions despite longstanding disease (mean 21.5 years). Four of the 10 patients with mild deformity exhibited prominent soft tissue pathology, with minimal destruction of bone; the other 6 patients had bony alterations that resembled rheumatoid arthritis.Conclusion. In SLE patients with arthritis of the finger joints, MRI detects characteristic signs of soft tissue pathology (e.g., capsular swelling, edematous and proliferative tenosynovitis, synovial hypertrophy) and bony alterations (e.g., erosions, some of which are missed by conventional radiography). MRI thus helps to distinguish different types of lupus arthritis/Jaccoud's arthropathy, which allows more differentiated treatment strategies and monitoring.

Magnetic resonance imaging evidence of tendinopathy in early rheumatoid arthritis predicts tendon rupture at six years

“…MRI features of tenosynovitis have also been described in other conditions including spondylarthropathies (19) and systemic lupus erythematosus (20). An interesting point of difference between lupus-associated Jaccoud's arthropathy and RA is that the flexor tendons are more often involved in the 748 McQUEEN ET AL former condition, as opposed to extensor tendons in the latter (20). Although we did not investigate healthy subjects in this study, MRI scans from normal subjects have been studied by others (3,10).…”

“…Ostendorf et al recently described their own tendinopathy scoring system as an add-on to the OMERACT score when describing pathology at the metatarsophalangeal joints in patients with very early RA (8). MRI features of tenosynovitis have also been described in other conditions including spondylarthropathies (19) and systemic lupus erythematosus (20). An interesting point of difference between lupus-associated Jaccoud's arthropathy and RA is that the flexor tendons are more often involved in the 748 McQUEEN ET AL former condition, as opposed to extensor tendons in the latter (20).…”

Rhupus; unusual presentations

“…However, according to the ACR criteria set for SLE, only non-erosive arthritis is defined as SLE arthropathy [11,16]. This fact reinforces the importance of joints assessment by imaging techniques including X-ray, MRI, and musculoskeletal ultrasound (US) [12,17,18]. These techniques allow better classification and differentiation of SLE arthropathy from Rhupus syndrome, especially when physical examination is not conclusive or when the patient suffers from a severe persistent joint disease.…”

Overlapping juvenile idiopathic arthritis and systemic lupus erythematosus: a case report

“…Synovitis and arthritis are typical features of almost all inflammatory rheumatic disorders, but the localization and the extent of the inflamed joints and erosions could help in the differential diagnosis. Erosive arthritis in SLE is unusual and only a minority of patients develop deforming a non-erosive, RF-negative process, denoted as "Jaccoud's arthropathy" (20).…”