Jaccoud’s arthritis

Jaccoud’s arthritis

Abstract: Jaccoud’s arthritis is a deforming arthritis of the small joints of the hand and feet secondary to rheumatic fever. Now the term Jaccoud’s arthropathy is being used for similar pattern with SLE and other immune mediated disorders.

Jaccoud’s arthritis is a deforming arthritis of the small joints of the hand and feet secondary to rheumatic fever [1]. Usually rheumatic fever involves the major joints and is a non-deforming arthritis. Jaccoud’s arthritis is due to periarticular fibrosis and it is called as a correctable deformity, unlike the deformity in rheumatoid arthritis which is fixed. Earlier on, when rheumatic fever was quite frequent, Jaccoud’s arthritis used to be confused with rheumatoid arthritis because of the deforming nature similar to rheumatoid arthritis [2]. Separation was occasionally more difficult when there was a family history of rheumatoid arthritis and a positive rheumatoid factor [3].

In a prospective study involving 400 patients with rheumatic valvular heart disease, 17 patients had diagnostic features of Jaccoud’s arthropathy [4]. All these patients had a past history of acute arthritis. None of them had pain, signs of inflammation or functional deficit at the time of diagnosis of Jaccoud’s arthropathy. Other causes of joint deformity were ruled out by radiological and serological studies.

Though conventionally Jaccoud’s arthritis has been considered as a delayed manifestation of rheumatic fever, now a days, similar findings are more commonly reported in systemic lupus erythematosus (SLE) [5]. Jaccoud’s arthropathy is characterized by swan neck deformity, ulnar deviation and Z-thumb as in rheumatoid arthritis, but can be corrected passively and there is no bone erosion noticeable on plain radiographs. Bone erosions and other structural changes may be documented by magnetic resonance imaging.

Typical features of Jaccoud’s arthropathy has been reported in patients with sarcoidosis [6,7]. Jaccoud’s arthropathy has also been reported after treatment with nivolumab, a novel immune checkpoint blocker, given for metastatic clear cell renal cell carcinoma [8]. There were no diagnostic features of SLE in this patient.

References

1. Jaccoud S.  Legons de clinique medicale faites a l’ Hopital de la Charite, 2nd ed. Delahaye, Paris. 1869.
2. Levin EB. Jaccoud’s arthritis. Post-rheumatic fever complication–not rheumatoid arthritis. Calif Med. 1970 Apr;112(4):19-22.
   
3. Burda CD, Sanders CV. Chronic postrheumatic-fever (Jaccoud’s) arthritis. Case report with the rheumatoid factor and a family history of rheumatoid arthritis. Arch Intern Med. 1967 Dec;120(6):712-6.
   
4. Moro C, Castro C, Lanza MG, Font de Mora A, Cosio FG, Ruigomez L, Schuller A. Jaccoud’s arthropathy in patients with chronic rheumatic valvular heart disease. Eur J Cardiol. 1978 Feb;6(6):459-68.
   
5. Santiago MB, Galvão V, Ribeiro DS, Santos WD, da Hora PR, Mota AP, Pimenta E, Oliveira I, Atta AM, Reis MG, Reis EA, Lins C. Severe Jaccoud’s arthropathy in systemic lupus erythematosus. Rheumatol Int. 2015 Oct;35(10):1773-7.
6. Sukenik S, Hendler N, Yerushalmi B, Buskila D, Liberman N. Jaccoud’s-type arthropathy: an association with sarcoidosis. J Rheumatol. 1991 Jun;18(6):915-7.
   
7. Lima I, Ribeiro DS, Cesare A, Machado WG, Santiago MB. Typical Jaccoud’s arthropathy in a patient with sarcoidosis. Rheumatol Int. 2013 Jun;33(6):1615-7.
8. de Velasco G, Bermas B, Choueiri TK. Auto-immune arthropathy and uveitis as complications from PD-1 inhibitor. Arthritis Rheumatol. 2016 Feb;68(2):556-7.