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Moura CA, Fonseca V, Appenzeller S, Santiago MB. Lupus Arthropathy: An Evolving Concept. J Clin Rheumatol 2024; 30:e39-e40. [PMID: 37038257 DOI: 10.1097/rhu.0000000000001966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/12/2023]
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Vittecoq O, Brevet P, Lebel N, Lequerré T. Lupus With Erosive Arthritis: A Singular Joint Phenotype of Lupus or Rhupus? J Clin Rheumatol 2024; 30:e41. [PMID: 37038258 DOI: 10.1097/rhu.0000000000001967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/12/2023]
Affiliation(s)
- Olivier Vittecoq
- Department of Rheumatology and CIC-CRB 1404, Inserm 1234, Rouen University, Rouen, France
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Moura CA, Fonseca V, Alves EM, Silva de Oliveira I, Santiago MB. Clinical disease activity index applicability in lupus arthropathy: Unraveling underdiagnosed joint activity. Lupus 2023; 32:1402-1408. [PMID: 37844912 DOI: 10.1177/09612033231206454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2023]
Abstract
INTRODUCTION Lupus arthropathy (LA) ranges from arthralgia and non-deforming arthritis to severe forms such as Jaccoud-type deformities and mutilating arthritis. Considering the evolving concept of LA, measuring arthritis activity in lupus patients may require a more practical and sensitive tool other than the classical composite scores. METHODS In this cross-sectional study, we evaluated the articular pattern of a sample of SLE patients which were divided into those that scored in articular domain on Systemic Lupus Erythematosus Disease Activity Index 2000 (SLEDAI-2K) and those with activity arthritis using the Clinical Disease Activity Index (CDAI). After all, we analyzed the association between CDAI and arthritis by SLEDAI-2K as well as its association with the presence or not of Jaccoud-type arthropathy (JA). RESULTS A total of 127 patients with SLE were evaluated. According to SLEDAI-2K, 17 (13.4%) patients have scored in its joint criteria and 32 patients (25.19%) were considered to have some articular activity by CDAI. A total of 16 patients (50%) who scored some activity on CDAI did not score in articular domain of SLEDAI-2K. Also, the presence of Jaccoud-type arthropathy was significantly associated with arthritis activity according to the CDAI score (p = .014) but not with SLEDAI-2K joint criteria (p = .524). CONCLUSION The CDAI was not directly associated with the presence of arthritis by the joint criteria of SLEDAI-2K and the presence of JA was significantly associated with the CDAI but not with arthritis at SLEDAI-2K.
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Affiliation(s)
- Carlos Antonio Moura
- Department of Internal Medicine, Sister Dulce's Social Works, Santo Antonio's Hospital, Salvador, Brazil
- Department of Medicine, Bahiana - School of Medicine and Public Health, Salvador, Brazil
| | - Vanessa Fonseca
- Department of Medicine, Bahiana - School of Medicine and Public Health, Salvador, Brazil
| | - Eneida M Alves
- Department of Medicine, Bahiana - School of Medicine and Public Health, Salvador, Brazil
| | | | - Mittermayer B Santiago
- Department of Medicine, Bahiana - School of Medicine and Public Health, Salvador, Brazil
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Santiago MB. Jaccoud-type lupus arthropathy. Lupus 2022; 31:398-406. [DOI: 10.1177/09612033221082908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background: Jaccoud’s arthropathy (JA) is a condition characterized by joint deformities that have a “reducible” pattern, that is, they return to the normal appearance with a passive manoeuvre. JA was described in patients with rheumatic fever (RF) more than a century ago, and presently, the majority of the patients have systemic lupus erythematosus (SLE). Purpose: The aim of this review is to draw one attention to the epidemiology, pathogenesis, histopathology, clinical features, imaging, and management of JA in patients with SLE (Jaccoud-type lupus arthropathy). Data collection: The search strategy included articles retrieved from PubMed utilizing the terms “lupus arthropathy”, “lupus deforming arthropathy”, “lupus hand”, “lupus foot”, “chronic postrheumatic arthropathy”, “Jaccoud’s” and “Jaccoud” from 1950 until March 2021, with no language restriction. Results: The prevalence of Jaccoud-type arthropathy in SLE is approximately 5%. The aetiopathogenic mechanisms of JA are not yet known. The most common joint deformities of JA, are ulnar deviation, swan neck, and the “z” of the thumb. Unfortunately, none of the proposed classification criteria for JA have been validated so far. Characteristically, there is no bone erosion on plain radiographs of the joints, but more sensitive imaging methods, magnetic resonance imaging or high-performance ultrasound may reveal small bone erosions. There is no preventive measure against JA development, specific clinical treatment or convincing surgical approach for correcting the deformities. Conclusion: As daily activities and quality of life are compromised in patients with JA, other studies are urgently needed in this area.
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Pimenta da Fonseca E, Lins CF, de Sá Ribeiro DL, Santos WGD, Rosa G, Machicado V, Pedreira AL, Souza APMD, Baleeiro C, Dos Santos Ferreira LG, de Oliveira IS, da Silva JPCG, Atta AM, Santiago MB. Videocapillaroscopic Findings in Patients With Systemic Lupus Erythematosus With or Without Jaccoud Arthropathy. J Clin Rheumatol 2021; 27:S198-S203. [PMID: 33337816 DOI: 10.1097/rhu.0000000000001617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND/OBJECTIVE Systemic lupus erythematosus (SLE) is an autoimmune disease that can present changes in blood vessels, which can be evaluated by periungual nailfold videocapillaroscopy (VCP). This technique is important for the diagnosis of systemic sclerosis and to identify individuals with Raynaud phenomenon at higher risk of developing systemic sclerosis. This study aims to describe the videocapillaroscopic profile of a series of SLE patients and to investigate if the VCP pattern is different among those with Jaccoud arthropathy (JA) compared with those without. METHODS Between September 2014 and March 2015, the patients in this study underwent VCP, clinical evaluation, and laboratory tests. The capillaroscopic patterns were defined as minor, major, and scleroderma (SD). The presence of capillaroscopic findings, such as elongated capillaries, tortuosity, ectasia, prominent venous plexus, neoangiogenesis, hemorrhage, and megacapillaries, were also observed. Associations were calculated using the χ2, Fisher exact, or Student t test. RESULTS In a population of 113 females with SLE (67 without JA and 46 with JA), at least 1 alteration was observed in VCP in 89.40% of them, among which "nonspecific changes" were the most prevalent. Minor changes were seen in 39 (58.2%) and 26 (56.5%), major changes in 21 (31.3%) and 11 (23.9%), and SD pattern in 2 (3.0%) and 3 (6.5%), in the patients without and with JA, respectively (p > 0.05). CONCLUSIONS The majority of patients with SLE demonstrated changes in the VCP examination, but this tool did not allow discrimination between those with or without JA.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | - Ajax Merces Atta
- Department of Clinical and Toxicological Analysis, Faculty of Pharmacy, Federal University of Bahia
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Sousa APMD, de Souza Costa GC, de Oliveira Costa GN, Barbosa LM, Grassi MFR, Monteiro MEH, Dos Reis MG, Barreto ML, Pedreira AL, Ribeiro DS, Lins CF, Galvão V, Santos WGD, Machicado V, da Fonseca EP, Silva CBR, Santiago MB. Genetic Polymorphisms in Patients With Systemic Lupus Erythematosus and Jaccoud Arthropathy: A Pilot Study. J Clin Rheumatol 2021; 27:S193-S197. [PMID: 34525002 DOI: 10.1097/rhu.0000000000001653] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Jaccoud arthropathy (JA) is a nonerosive and deforming arthropathy experienced frequently by patients with systemic lupus erythematosus (SLE). Although genetic polymorphisms are associated with SLE development, the association between genetic polymorphisms and JA has not been studied to date. The main objective of this study was to evaluate an association between HLA, STAT4, IRF5, and BLK polymorphisms and the presence of JA in Brazilian individuals with SLE. METHODS Patients were selected from a cohort of individuals with SLE followed at 2 rheumatology reference centers in Salvador, Bahia, Brazil. The JA diagnosis was based on clinical and radiological criteria. The participants were genotyped for rs9271100, rs7574865, rs10488631, and rs13277113 polymorphisms in the HLA, STAT4, IRF5, and BLK genes, respectively, using real-time polymerase chain reaction. The presence of JA was correlated with allele frequencies, and clinical and laboratory data. RESULTS One hundred forty-four individuals with SLE (38 with JA and 106 with SLE without JA) were studied. The mean age of the patients was 45 ± 12 years; the majority were women and had brown skin. Patients with JA had a longer disease duration than patients without JA. Serositis and neuropsychiatric manifestations were more frequent in the JA population. The A allele of rs13277113 in the BLK gene was associated with the presence of JA. CONCLUSIONS The rs13277113 polymorphism in the BLK gene was found to be a possible genetic risk for JA development. However, further studies in larger populations should be performed to confirm this finding.
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Clinical significance of serum and urinary interleukin-6 in systemic lupus erythematosus patients. EGYPTIAN RHEUMATOLOGIST 2017. [DOI: 10.1016/j.ejr.2016.05.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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Najm A, Le Goff B, Achille A, Espitia O, Durant C, Perrin F, Agard C. [Three cases of Jaccoud's arthropathy during systemic sclerosis]. Rev Med Interne 2016; 37:708-713. [PMID: 26869295 DOI: 10.1016/j.revmed.2016.01.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2015] [Revised: 01/06/2016] [Accepted: 01/11/2016] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Jaccoud's arthropathy (JA) is a chronic and non-erosive deforming arthropathy, usually affecting the hands. JA pathophysiology is poorly known but involves periarticular structures such as tendons and the joint capsule. JA is associated with various conditions including the connective tissue disease, especially systemic lupus erythematosis. JA has been rarely described and studied in systemic sclerosis. CASE REPORTS We report the clinical histories of 3 patients with systemic sclerosis (ScS) who developed JA. One patient had a systemic limited disease and the 2 others a cutaneous limited disease ; mean age of the patients was 79.3 years. Systemic sclerosis was diagnosed respectively 19, 1 and 21 years prior to the development of JA. One of the 3 patients had a past clinical history of discoid lupus. For 1 out of the 3 patients, JA appeared whereas the ScS was completely stable. The disease was still active in the 2 remaining patients, with concurrent pulmonary hypertension diagnosis. Deformities increased during years (Z thumbs, ulnar deviation), leading to mild to severe disability. No benefit from either prednisone (n=2) or a combination of prednisone and methotrexate (n=1) was obtained. CONCLUSION We described 3 cases of Jaccoud's arthropathy among our scleroderma cohort of 296 patients (1%). This arthropathy worsens hand functional disability. Its pathophysiology is unknown and optimal therapeutic approach remains to establish.
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Affiliation(s)
- A Najm
- Service de rhumatologie, pôle hospitalo-universitaire 4, hôpital Hôtel-Dieu, place Alexis-Ricordeau, 44093 Nantes cedex 1, France
| | - B Le Goff
- Service de rhumatologie, pôle hospitalo-universitaire 4, hôpital Hôtel-Dieu, place Alexis-Ricordeau, 44093 Nantes cedex 1, France
| | - A Achille
- Service de médecine interne, pôle hospitalo-universitaire 3, centre de compétences maladies systémiques et auto-immunes rares, hôpital Hôtel-Dieu, place Alexis-Ricordeau, 44093 Nantes cedex 1, France
| | - O Espitia
- Service de médecine interne, pôle hospitalo-universitaire 3, centre de compétences maladies systémiques et auto-immunes rares, hôpital Hôtel-Dieu, place Alexis-Ricordeau, 44093 Nantes cedex 1, France
| | - C Durant
- Service de médecine interne, pôle hospitalo-universitaire 3, centre de compétences maladies systémiques et auto-immunes rares, hôpital Hôtel-Dieu, place Alexis-Ricordeau, 44093 Nantes cedex 1, France
| | - F Perrin
- Service de médecine interne, pôle hospitalo-universitaire 3, centre de compétences maladies systémiques et auto-immunes rares, hôpital Hôtel-Dieu, place Alexis-Ricordeau, 44093 Nantes cedex 1, France
| | - C Agard
- Service de médecine interne, pôle hospitalo-universitaire 3, centre de compétences maladies systémiques et auto-immunes rares, hôpital Hôtel-Dieu, place Alexis-Ricordeau, 44093 Nantes cedex 1, France; Inserm UMR1087, CNRS UMR6291, unité de recherche de l'Institut du thorax, équipe 2 « Signalisation et hypertension artérielle », IRS université de Nantes, 8, quai Moncousu, BP 70721, 44007 Nantes cedex 1, France.
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Affiliation(s)
- Mittermayer B Santiago
- Department of Internal Medicine, Escola Bahiana de Medicina e Saúde Pública, Salvador, Brazil.
| | - Viviane Machicado
- Department of Internal Medicine, Escola Bahiana de Medicina e Saúde Pública, Salvador, Brazil
| | - Daniel S Á Ribeiro
- Department of Internal Medicine, Escola Bahiana de Medicina e Saúde Pública, Salvador, Brazil
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Santiago MB, Galvão V, Ribeiro DS, Santos WD, da Hora PR, Mota AP, Pimenta E, Oliveira I, Atta AM, Reis MG, Reis EAG, Lins C. Severe Jaccoud's arthropathy in systemic lupus erythematosus. Rheumatol Int 2015; 35:1773-7. [PMID: 26310503 DOI: 10.1007/s00296-015-3351-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2015] [Accepted: 08/18/2015] [Indexed: 11/30/2022]
Abstract
Jaccoud's arthropathy (JA) is a clinical situation nowadays present mostly in systemic lupus erythematosus (SLE). It is characterized by the presence of joint deformities such as "swan neck," ulnar deviation and "Z-thumb" resembling rheumatoid arthritis (RA) but that are passively correctable and without bone erosion on plain radiographs. From our cohort of SLE patients with JA, we selected a subgroup with a more severe form of this arthropathy and looked at their clinical and laboratory profile as well as studied the magnetic resonance imaging (MRI) findings or ultrasound (US) obtained from the hand with most evident deformities. Seven SLE patients with a severe form of JA were identified. All seven patients have "swan neck," ulnar deviation and "Z-thumb" deformities. Two out of seven had "mutilans-type JA" and four had fixed deformities in the metacarpophalangeal (MCP) joints. The MRI of the hand with more evident deformity clinically performed in six cases and US performed in one case showed mild synovitis in five and moderate synovitis in two patients, mild flexor tenosynovitis in six and severe tenosynovitis in one. Only two small bone erosions were observed in the second and third MCP joints of one patient with moderate synovitis. Severe JA compromises the functional capacity of the joints and imposes the risk of misdiagnosis of RA. With the improvement of the survival rate of SLE and the lack of specific prophylactic or therapeutical measures for JA, it is reasonable to assume that more and more cases of severe JA are going to be identified.
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Affiliation(s)
- Mittermayer B Santiago
- Escola Bahiana de Medicina e Saúde Pública, Av. Dom João VI, 275, Brotas, Salvador, BA, 40290-000, Brazil. .,Serviços Especializados em Reumatologia da Bahia, Rua Conde Filho, 117, Graça, Salvador, BA, 40150-150, Brazil.
| | - Verena Galvão
- Escola Bahiana de Medicina e Saúde Pública, Av. Dom João VI, 275, Brotas, Salvador, BA, 40290-000, Brazil
| | - Daniel Sá Ribeiro
- Escola Bahiana de Medicina e Saúde Pública, Av. Dom João VI, 275, Brotas, Salvador, BA, 40290-000, Brazil
| | - Willer D Santos
- Escola Bahiana de Medicina e Saúde Pública, Av. Dom João VI, 275, Brotas, Salvador, BA, 40290-000, Brazil
| | - Priscila R da Hora
- Escola Bahiana de Medicina e Saúde Pública, Av. Dom João VI, 275, Brotas, Salvador, BA, 40290-000, Brazil
| | - Anna Paula Mota
- Escola Bahiana de Medicina e Saúde Pública, Av. Dom João VI, 275, Brotas, Salvador, BA, 40290-000, Brazil
| | - Emanuela Pimenta
- Escola Bahiana de Medicina e Saúde Pública, Av. Dom João VI, 275, Brotas, Salvador, BA, 40290-000, Brazil
| | - Isabela Oliveira
- Departamento de Análises Clínicas e Toxicológicas, Faculdade de Farmácia, Universidade Federal da Bahia, Salvador, BA, 40000-000, Brazil
| | - Ajax M Atta
- Departamento de Análises Clínicas e Toxicológicas, Faculdade de Farmácia, Universidade Federal da Bahia, Salvador, BA, 40000-000, Brazil
| | - Mitermayer G Reis
- Laboratório de Biologia Molecular-Fundação Gonçalo Muniz (Fiocruz), Salvador, BA, 40000-000, Brazil
| | - Eliana A G Reis
- Laboratório de Biologia Molecular-Fundação Gonçalo Muniz (Fiocruz), Salvador, BA, 40000-000, Brazil
| | - Carolina Lins
- Escola Bahiana de Medicina e Saúde Pública, Av. Dom João VI, 275, Brotas, Salvador, BA, 40290-000, Brazil
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