The question of whether bone erosion is a feature of Jaccoud arthropathy has remained controversial among persons who have systemic lupus erythematosus (SLE).
A new case report could help clinicians better diagnose SLE in patients who have systemic lupus erythematosus (SLE) and develop joint deformities with or without bone erosion.
The report, published in Immunity, Inflammation, and Disease, documents the case of a 27-year-old woman with SLE who received a diagnosis of Jaccoud arthropathy (JA). Investigators say the case is a meaningful example of how to distinguish JA from a similar condition, rhupus syndrome.
The case authors wrote that JA is typically characterized by joint deformation in the hands and feet without bone erosion. It is seen alongside several diseases, such as psoriatic arthritis and Sjögren’s syndrome, but it is most prevalent in SLE, where 1% to 5% of patients are believed to be affected.
Yet, despite its relative prevalence, the authors said there are not yet any unified standards for diagnosing JA. In some cases, studies suggest that bone erosion is present in JA, but that premise remains controversial, noted this authors of this case report.
In the instance presented in the case report, a woman presented to First Affiliated Hospital of Guangzhou University of Chinese Medicine 5 years after her SLE diagnosis with class V lupus nephritis. At the time of her admission, the patient said she had been experiencing pain and swelling in her joints for 2 years and that she had developed progressively worsening deformities in her hands and feet.
Clinicians examined the patient and performed several tests, finding that she had an elevated erythrocyte sedimentation rate and heightened levels of C-reactive protein. She also had several SLE-associated biomarkers, including antinuclear antibodies and anti–double-stranded DNA antibodies, along with decreased complement C3 and C4.
The patient had joint dislocation evidence on radiography, but she did not have evidence of bone erosion.
The investigators diagnosed JA and prescribed oral prednisone (10 mg daily), tofacitinib (Xeljanz; 5 mg twice daily), methotrexate (MTX; 10 mg weekly), and celecoxib (Celebrex; 0.2 g twice daily). The patient’s symptoms improved, and at a 4-month follow-up appointment, there was no sign of progression.
The case report authors said joint pain is not uncommon in SLE, but they said it is important for clinicians to get to the bottom of such pain.
“Considering the differences between the clinical manifestations and the disease outcome, as well as the impact on the quality of life (simple joint pain or inability to twist the towel with deformed fingers), it is necessary to distinguish deforming arthropathy complicated with SLE from simple joint symptoms,” they wrote.
In some cases, that diagnosis may come down to a choice between JA and rhupus syndrome. In such instances, the authors proposed that the presence or absence of bone erosion ought to be the pivotal distinction.
“We believe that patients with SLE and erosive JA should be regarded as having rhupus, and we posit that bone erosion is the key to distinguishing rhupus from JA,” they wrote. “Moreover, we found that the use of tofacitinib, MTX, and celecoxib in combination with prednisone may be an effective regimen for the treatment of JA.”
The authors said their findings need to be verified in future studies. In the meantime, they said clinicians should regularly examine the joints of patients with SLE to monitor for the possible development of conditions like JA and rhupus.
Chen SL, Zheng HJ, Zhang LY, Xu Q, Lin CS. Case report: joint deformity associated with systemic lupus erythematosus. Immun Inflamm Dis. 2022;10(10):e717. doi:10.1002/iid3.717