Jaccoud’s Arthropathy

Santiago M, Machicado V. Images in Clinical Medicine: Jaccoud’s Arthropathy. N Engl J Med 2015; 373:e1July 2, 2015. DOI: 10.1056/NEJMicm1410743

In Jaccoud’s arthropathy, which is often found in systemic lupus eythematosus (SLE), hand deformities result from soft-tissue abnormalities, rather than the destruction of bone joints, which occurs in rheumatoid arthritis.

This 58-year-old man had a 15-year history of SLE with polyarthritis, treasted with glucocorticoids, hydroxychloroquine, and azathioprine.

Hand deformities developed over 10 years, including swan neck deformity, Z deformity of the thumb, and ulnar deviation of the fifth digit.

The management of Jaccoud’s arthropathy includes physical therapy and orthotic devices. The patient was a taxi driver, and despite physical therapy, the hand deformities were interfering with his work. Soft-tissue surgery is being considered.

This article contains a series of images and a video showing the development of the patient’s condition over 10 years.