JACCOUDS ARTHROPATHY

Abstract

Jaccoud's Arthropathy (JA) is a chronicdeforming arthritis of the small joints of thehand and feet initially described secondary torheumatic fever. It is due to periarticular fibrosisand is classically known as a correctablenonerosive deformity, unlike the deformity inrheumatoid arthritis which is erosive, fixed andnoncorrectable

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Short Reports: Clinical Images in Medicine
JACCOUDS ARTHROPATHY
Srinivasan N, Saikumar K. S
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Introduction
Jaccoud's Arthropathy (JA) is a chronic
deforming arthritis of the small joints of the
hand and feet initially described secondary to
rheumatic fever. It is due to periarticular fibrosis
and is classically known as a correctable
nonerosive deformity, unlike the deformity in
rheumatoid arthritis which is erosive, fixed and
noncorrectable
The authors would like to emphasise with this
image-report that distinguishing fixed swan
neck deformity of rheumatoid arthritis from the
correctible Jaccouds Arthropathy is important
as it can result in more judicious investigations
and attributing a benign prognosis to the
condition.
Key Words: Jaccouds Arthropathy, Arthritis
Description
A 71 year old female presented for a general
health check up with profound deformities of
her hands. Examination revealed ulnar
deviation at MCP joints , hyperextension at the
PIP joints with flexion of the DIP joints( Panel
A).The deformities of the hands were
voluntarily reducible without pain (Panel B ).
She never had symptoms of active arthritis and
could not recall the exact duration of
arthropathy. She showed little functional
impairment despite the severity of the
deformities. The patient did not have any
history of rheumatic fever, rheumatoid arthritis
or SLE (systemic lupus erythematosis). Xrays
of the hands did not show any periarticular
osteoporosis or erosions. ESR was 16mm 1st
hour with negative rheumatoid factor and ANA.
Severe chronic correctible joint deformity with
no or minimal osseous destruction suggests
Jaccouds Arthropathy (JA).
Discussion
Jaccoud's Arthropathy (JA) is a chronic
deforming arthritis of the small joints of the
hand and feet. Severe deformation of the
hands in JA include ulnar deviation of MCP
joints, Swan neck deformity viz hyperextension
at the PIP (proximal interphalangeal) joints with
flexion of the DIP(distal interphalangeal) joints
and Z deformity of the thumb. There may be
involvement of the toes as well. The bony
involvement is non-erosive with mild aches and
little or no evidence of synovitis 1. JA was
originally described as a complication of
recurrent rheumatic fever 2 and its association
has also been reported with systemic lupus
erythematosus ,other connective tissue
diseases like dermatomyosits, overlap
syndrome, psoriatic arthritis, urticarial
vasculitis, inflammatory bowel disease,
malignancy and pyrophosphate arthropathy3.
There are no established definite criteria for the
diagnosis of JA and an inflammatory process in
the periarticular softissues is though to be the
primary cause 1,4. The prognosis is benign with

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the chronic deformities persisting for years
without much functional impairment.

The clinical significance of JA lies in
differentiating it from the erosive fixed and
noncorrectable deformity of rheumatoid
arthritis.











Panel A Panel B

References
1 van Vugt RM, Derksen RHWM, Kater J, Bijlsma JWJ.
Deforming arthropathy or lupus and rhupus hands in
systemic lupus erythematosus. Ann Rheum
Dis1998;57:540–4.
2 Jaccoud FS. Sur une forme de rhumatisme chronique.
Leçons de clinique médicale faites à l'Hôpital de la Charité.
Paris: Delahaye, 1869:598–616.
3 Palazzi, C., D'Amico, E., De Santis, D., Petricca, A.
Jaccoud's arthropathy of the hands as a complication of
pyrophosphate arthropathy. Rheumatology (Oxford)
2001;40: 354-355
4 Spronk PE, ter Borg EJ, Kallemberg CGM. Patients with
systemic lupus erythematosus and Jaccoud's arthropathy:
a clinical subset with an increased C reactive protein
response? Ann Rheum Dis1992;51:358–61

Corresponding author:
Dr Srinivasan N, M.D.
SRM Medical College Hospital, SRM University, Kattankulathur, Chennai, India 602 203
Address for communication: New No 9 , Old No 20, 2nd Floor, Puliyur Main
Road, Trustpuram, Kodambakkam, Chennai 600024 Email: cardiodoc2006@gmail.com