Sonographic Findings of Hands and Wrists in Systemic Lupus Erythematosus Patients With Jaccoud Arthropathy

Lins, Carolina Freitas; Ribeiro, Daniel Lima de Sá; Santos, Willer Gonçalves Dourado; Rosa, Genevievi; Machicado, Viviane; Pedreira, Ana Luisa Souza; Fonseca, Eduardo Oyama Lins; Souza, Anna Paula Mota Duque; Silva, Carla Baleeiro Rodrigues; Ferreira, Luana Grazielle dos Santos; Galvão, Verena; Oliveira, Ilka Regina Souza de; Atta, Ajax Mercês; Santiago, Mittermayer Barreto

doi:10.1097/rhu.0000000000000622

Cited by 10 publications

(6 citation statements)

References 21 publications

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Section: Discussionsupporting

confidence: 87%

“…Both patients were negative for ACPA and RF; however, the synovitis, ESR, and CRP status of the patients were not mentioned, and therefore, RA diagnosis cannot be excluded. Similar flaws appeared in the findings of Ribeiro et al, Lins et al, and Sá Ribeiro et al 16,21,22 While there are currently no diagnostic criteria for RA, classification criteria can be used to assist the diagnosis. 23 When a JA patient has more than 10 joints involved, accompanied by synovitis and elevated CRP levels or ESR, RA can be diagnosed according to the 2010 American College of Rheumatology (ACR)/European Alliance of Association for Rheumatology RA classification criteria.…”

Section: Discussionsupporting

confidence: 66%

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Case report: Joint deformity associated with systemic lupus erythematosus

Chen

Zheng

Zhang

et al. 2022

Immunity Inflam & Disease

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Objective Typically, Jaccoud arthropathy (JA) is characterized by joint deformation without bone erosion. However, some recent studies have shown that bone erosion also occurs in JA; however, this remains controversial. To date, there have been no unified diagnostic standards for JA. Herein, we report a case of systemic lupus erythematosus complicated with JA without bone erosion. Methods A 27‐year‐old woman was admitted to our department with a 2‐year history of pain, swelling, and progressive deformities of her hands and feet. She was diagnosed with systemic lupus erythematosus and class V lupus nephritis 5 years prior. Upon examination, her erythrocyte sedimentation rate and C‐reactive protein levels were found to be increased. She was positive for antinuclear antibodies, antidouble stranded DNA antibodies, and antiextractable nuclear antigen antibodies, with a decreased complement C3 and C4. Radiography and magnetic resonance imaging revealed no bone erosion. The patient was diagnosed with JA. She was treated with oral prednisone (10 mg daily), tofacitinib (5 mg twice daily), methotrexate (10 mg weekly), and celecoxib (0.2 g twice daily). Results The patient's joint symptoms improved after treatment. No further progress was observed during the 4‐month follow‐up period. Conclusion We believe that bone erosion is the key to distinguish rhupus syndrome from JA. However, this needs to be confirmed with further long‐term follow‐up studies. We found that the use tofacitinib, MTX, and celecoxib in combination with prednisone may be an effective regimen for the treatment of JA.

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Section: Discussionsupporting

confidence: 87%

Section: Discussionsupporting

confidence: 66%

Case report: Joint deformity associated with systemic lupus erythematosus

Chen

Zheng

Zhang

et al. 2022

Immunity Inflam & Disease

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“…Synovitis was observed in 67.3%, tenosynovitis in 38.5% and in 5.3% in small areas of erosions. Similarly, Lins et al 14 examined 40 patients and 560 joints by US; 47.5% had synovial hypertrophy, 22.5% had tenosynovitis and 5.0% small erosions; there was no association between these findings and disease activity (p=0.33).…”

Section: Discussionmentioning

confidence: 96%

Jaccoud’s arthropathy in SLE: findings from a Latin American multiethnic population

et al. 2019

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ObjectiveTo compare the clinical, laboratory and outcome features of SLE patients with and without Jaccoud’s arthropathy (JA) from the Grupo Latino Americano De Estudio del Lupus (GLADEL) cohort.Methods1480 patients with SLE [(34 centres, 9 Latin American countries with a recent diagnosis (≤2 years)] constitute the GLADEL cohort. JA was defined as reducible deformity of the metacarpophalangeal axis, without radiographic erosions at any time. Within this cohort, a nested case–control study was carried out. Control was matched for age, gender and centre in a 1:3 proportion. The variables included were: sociodemographic, clinical and immunological features, disease activity, damage and mortality. Comparisons were performed with Wilcoxon and χ2 tests for continuous and categorical variables, respectively. ORs and 95% CIs and Kaplan-Meier survival curve were estimated.ResultsOf 1480 patients, 17 (1.1%) JA patients were identified; 16 (94.1%) of them were women, mean age: 31.0 years (SD 12.0). Five (29.4%) patients presented JA at SLE diagnosis and 12 (70.6%) after. The median follow-up time and all disease features were comparable in both groups except for a higher frequency of pneumonitis in the patients with JA [4 (23.5) vs 1 (2.0); p=0.012; (OR: 15.4; 95% CI 1.6 to 149.6)]. The SLE disease activity index, Systemic Lupus International Collaborating Clinics/American College of Rheumatology damage Index and the Kaplan-Meier survival curve were similar in both groups.ConclusionJA may tend to appear early in the course of SLE; it seems not to have an impact on disease activity, damage accrual or in survival.

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“…47 In contrast with these results, Lins and colleagues identified a low prevalence of US-detected erosive damage, observing this change only in 5% of patients. 48 We could hypothesize that the machine used for this assessment, equipped with a 14-MHz transducer, could influence this result, justifying this discrepancy.…”

Section: Systemic Lupus Erythematosus and Arthritis: Evidence From Im...mentioning

confidence: 95%

Erosive arthritis in systemic lupus erythematosus: not only Rhupus

Ceccarelli

Natalucci

Olivieri

et al. 2021

Lupus

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Systemic lupus erythematosus (SLE)–related arthritis has been traditionally defined as non-erosive and is therefore considered a minor manifestation requiring a mild treatment. However, the concept of non-erosive arthritis in SLE has been challenged with the advent of sensitive imaging techniques, such as high-resolution ultrasound with power Doppler or magnetic resonance. The application of these new imaging tools has demonstrated that up to 40% of SLE patients with joint involvement can develop erosive damage. Thus, this more aggressive phenotype can be identified not only in patients overlapping with rheumatoid arthritis (RA). This issue has been considered for the first time in the classification criteria proposed by Systemic Lupus International Collaborating Clinics in 2012, in which the old definition of “non-erosive arthritis” was replaced with either synovitis or tenderness in two or more joints with morning stiffness, suggesting the possible presence of an erosive phenotype. Accordingly, the 2019 EULAR/ACR’s SLE recommendations advise treatment with immunosuppressant or biological drugs for patients with RA-like moderate arthritis. As a result, several studies have investigated the presence of biomarkers associated with SLE erosive damage. A relevant role seems to be played by the autoantibodies directed against post-translational modified proteins: above all, a significant association has been observed with antibodies directed against citrullinated and carbamylated proteins. Conversely, the rheumatoid factor was not associated with this more aggressive SLE-related arthritis. Nonetheless, some pro-inflammatory factors have been associated with erosive damage in SLE patients. These results suggest new pathogenic mechanisms underlining erosive arthritis, only partially shared with RA. Hence, in the present narrative review, we summarized available data about erosive arthritis in SLE patients, in the light of its impact on therapeutic decisions.

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Sonographic Findings of Hands and Wrists in Systemic Lupus Erythematosus Patients With Jaccoud Arthropathy

Abstract: Ultrasound examination is a reliable and noninvasive imaging method for the evaluation of joint involvement in SLE. Half of the patients with JA have ultrasonographic signs of joint inflammation, and these abnormalities may be found even in the absence of disease activity.

Cited by 10 publications

References 21 publications

Case report: Joint deformity associated with systemic lupus erythematosus

Case report: Joint deformity associated with systemic lupus erythematosus

Jaccoud’s arthropathy in SLE: findings from a Latin American multiethnic population

Erosive arthritis in systemic lupus erythematosus: not only Rhupus

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