Rupture of the extensor tendons of the hand in lupus erythematosus disseminatus.

Abstract

There have been only sporadic reports of rupture of tendons in cases with lupus erythematosus (LE), e.g. rupture of the Achilles tendon (Cowan and Alexander, 1961; Lee, 1961;Bedi and Ellis, 1970) and rupture of the patellar tendon (Twining, Marcus, and Garey, 1964). We here present a case of spontaneous rupture of tendons in the hand of a male with LE. We were unable to find a similar report in the available literature, including The comprehensive book on lupus erythematosus by Dubois (1966).Case report A 58-year-old man was under the care of the Departments of Dermatology and Internal Medicine of our hospital. His illness had begun as a rash on and around the ear lobes which spread to the nape of the neck, face, and hands. The rash consisted of dark red patches with a tendency to converge on the forehead, nose, and cheeks. There were also haemorrhagic papules and a subfebrile fever. All these manifestations disappeared with the administration of 20 mg. prednisone a day. When the dose of steroids was reduced a year later the rash reappeared, accompanied by weakness and arthralgia. The skin biopsy was not conclusive, but the clinical diagnosis was compatible with LE.The erythrocyte sedimentation rate was 83 in the first hour and antinuclear factor was repeatedly found in the serum. Electrophoresis demonstrated type M gamma globulin of the IgG group which was constructed of light kappa-type chains. IgM was normal and IgA reduced. No LE cells were found in the blood.The patient was referred to the orthopaedic out-patient clinic after having observed a sudden inability to extend the fourth finger of his left hand. During the previous 24 years he had been taking 20 to 30 mg. prednisone daily. A spontaneous tear of the extensor tendon was diagnosed and the affected finger was immobilized for a month. There was no improvement and he was then operated upon. The dorsal aspect of the left hand was explored through a sinusoid incision extending from the wrist to the fourth metacarpophalangeal joint. The common extensor tendons to fingers 2, 3, and 4 were found to be split along their course into separate fibres. Some of the fibres were torn without any visible repair reaction; they were of normal colour. The extensor tendon to finger 4 was completely tom about 3 cm. proximal to the metacarpophalangeal joint. The extensor retinaculum at the wrist was opened, but no pathological findings, such as stricture, hypertrophy of the

Tendon ruptures in patients with systemic lupus erythematosus treated with corticosteroids

“…Certainly the role of steroids in slowing the healing process has been well studied (S), but their actual part in creating tendon pathology is less clear. In every instance where steroids have been implicated as a cause of tendon rupture, the underlying condition for which they were used can be cited as causal, eg RA (9), SLE (10)(11)(12)(13)(14) or athletic trauma (15).…”

“…Lotem et a1 (12) have suggested that a differentiation can be made between lupus degeneration and the effect of steroids by the presence or absence of an inflammatory infiltrate, respectively. He believes that both his case and others cited were primarily steroid induced.…”

“…Martin et a/ (13) 1958 Bilateral, patellar Cowan and Alexander (10) 1961 Bilateral, Achilles Lee (11) 1961 Bilateral, Achilles Twining et a/ (14) 1964 Bilateral, quadriceps Loten et a l (12) 1973 Extensor tendons of one hand Morgan and McCarty Present Paper Bilateral, patellar; extensor tendons of one hand were not removed. She had an extension lag of 10" 3 months after surgery.…”