Jaccoud arthropathy is manifested by joint abnormalities that resemble rheumatoid arthritis (RA), but are actively correctable and lack bone loss on radiographs without contrast. The pathophysiology of Jaccoud arthropathy is still unknown, and definitive diagnostic criteria are not established yet. A localized inflammatory process in the periarticular soft tissues is identified as the primary cause.
Jaccoud arthropathy causes second-to-fifth finger metacarpophalangeal joint dislocation and ulnar bending. It is considered a deforming arthropathy that affects the hands. Multiple conditions e.g autoimmune disorders are linked to jaccoud arthropathy which includes; cancer, psoriatic arthritis, IBD, recurrent rheumatic fever, and certain connective tissue diseases. Around 5% of people with rheumatic fever or systemic lupus erythematosus are affected by this condition.
However, in older, well-established abnormalities, the function of the implicated joints is restricted as a result of contractures caused by local residual fibrosis. Even though Jaccoud Arthropathy is ‘reversible’ and painless in certain cases, it is linked to significant reductions in quality of life.
Jaccoud Arthropathy Symptoms
Jaccoud arthropathy commonly affects the wrist, the metacarpophalangeal joints, and the joints in the feet. Jaccoud arthropathy is manifested by correctable or diminishable ulnar deformity and metacarpophalangeal joint deviation.
The several symptoms or signs of this disease are as follows:
- Ulnar deformity.
- Swan neck deformity of the fingers.
- Alignment abnormalities without visible erosions on radiographs.
- Progressive development of hand or foot deformity.
- Crepitus is also observed in certain patients, clinically severe tenosynovitis is only recorded in Jaccoud Arthropathy on a very rare occasion.
Jaccoud Arthropathy Causes
Severe Jaccoud Arthropathy reduces joint functional capability and increases the chance of a rheumatoid arthritis misdiagnosis. Jaccoud’s arthropathy is considered a consequence of recurring cases of rheumatic fever. Rheumatoid arthritis and other connective tissue illnesses like psoriatic arthritis, arthritis caused by chronic inflammation of the intestines, cancer, and systemic lupus erythematosus are considered the common causes of Jaccoud arthropathy. Patients lacking active arthritis also develop Jaccoud arthropathy. The pathophysiology of Jaccoud’s arthropathy is poorly defined but affects tendons and joint capsules.
Jaccoud Arthropathy Diagnosis
The initial radiographic bone shows a hook-like degradation of the metacarpal tip on the radial and palmar portion of their boundary in an anteroposterior projection. Plain X-rays typically demonstrate abnormalities and subluxations in individuals with Jaccoud Arthropathy.
” Hook” erosions can happen on the radial palmar side of the metacarpal heads. These erosions are different from the “margin” erosions that happen with rheumatoid arthritis.
Inflammation, obliteration of bone and cartilage, or degradation of articular surfaces are not symptoms of Jaccoud’s arthropathy. Most people with Jaccoud’s arthropathy do not have an abnormal ESR or rheumatoid factor test. Although the hands are most frequently affected, this illness has also been found to affect the feet.
Because the clinical symptoms of Jaccoud Arthropathy are similar to rheumatoid arthritis, it is critical to recognize the risk of misdiagnosis, which leads to ineffective treatment. Madelung’s deformity is an important differential diagnosis to consider. Madelung deformity causes several changes to the body’s structure. These changes cause biomechanical changes that lead to a smaller range of motion, less grip strength, and often pain. There is a hereditary element in the majority of patients with this illness.
Jaccoud Arthropathy Treatment
Physiotherapy and orthotic devices are used to treat Jaccoud’s arthropathy. The best treatment for Jaccoud’s arthropathy has yet to be determined. Currently, Jaccoud’s arthropathy is treated conservatively with non-hormonal anti-inflammatory medications, modest doses of corticosteroids, methotrexate, and antimalarials. Prednisone, alone or in conjunction with methotrexate, is little effective.
The goal of treatment is to relieve pain and keep damaged joints functional by using nonsteroidal anti-inflammatory medications, corticosteroids, antimalarial medicines, and physiotherapy. Surgery, such as osteotomy or stabilization with Kirschner intramedullary wire, is also an option for treating this deadly disease. Doctors also propose Benzathine Penicillin injectable prophylaxis, oral beta-blockers, low-dose diuretics, and hand physiotherapy.