Spontaneous tendon rupture in systemic lupus erythematosus: association with Jaccoud’s arthropathy

Abstract

Tendon rupture has rarely been described in patients with systemic lupus erythematosus. From observation of three cases of Jaccoud's arthropathy with tendon rupture, and considering that this arthropathy is more related to an inflammatory process of the tendon sheath than to synovitis per se, the intention of this study was to review the cases of tendon rupture in patients with systemic lupus erythematosus, in the hope of determining the frequency of Jaccoud's arthropathy associated with this complication. Systematic review using MEDLINE, Scielo and LILACS databases (1966 to 2009) and the following keywords: systemic lupus erythematosus, tendon rupture, Jaccoud's arthropathy. Secondary references were additionally obtained. Additionally, three Brazilian systemic lupus erythematosus patients who developed tendon rupture are described. Only 40 articles obtained fulfilled the previously established criteria. They were all case reports; the number of cases reported was 52 which, together with the three cases presented herein add up to 55 cases. Forty-six patients were women aged between 19 and 71 years, with a mean age of 40.1 +/- 12.4 years, and the average duration of the disease was 10 years. The most frequently observed rupture sites were the patellar and Achilles' tendons. While almost all patients described were on various doses of corticosteroids, 16 patients concomitantly had Jaccoud's arthropathy (29%). In conclusion, the association between Jaccoud's arthropathy and tendon rupture in systemic lupus erythematosus has been underestimated. As almost one-third of the systemic lupus erythematosus patients with tendon rupture also have Jaccoud's arthropathy, this arthropathy may be recognized as risk marker for tendon rupture.

Severe Jaccoud’s arthropathy in systemic lupus erythematosus

“…Another negative aspect linked to JA is the observation that it is a risk factor for tendon rupture. In one systematic review of the literature, in 55 SLE patients with tendon rupture, 16 (29 %) had JA [11]. This complication is probably related to an inflammatory process of the tendon sheath and consequent weakness of the tendon itself.…”

Spontaneous flexor tendon rupture due to an insufficiency fracture of the hamate hook in a patient with systemic lupus erythematosus: A case report

“…Chronic synovitis and tenosynovitis, arthritis, hand deformities such as Jaccoud’s arthropathy, local steroid injections, and long-term oral steroid use can contribute to degeneration and increase the vulnerability of the flexor tendon in patients with SLE [5], [6], [7]. There have been case reports of spontaneous tendon rupture in patients with SLE such as the Achilles tendon, patellar tendon and digital extensor tendons, but there have been few reports regarding flexor tendon rupture [8], [9], [10].…”

Maladies systémiques et vascularites

“…Elles intéressent notamment les tendons fléchisseurs Imagerie musculosquelettique -Pathologies générales des doigts et entraînent parfois un syndrome du canal carpien [10,72,228,240] . Elles intéressent notamment les tendons fléchisseurs Imagerie musculosquelettique -Pathologies générales des doigts et entraînent parfois un syndrome du canal carpien [10,72,228,240] .…”