Jaccoud's arthropathy- a rare but well known clinical entity

Jaccoud arthropathy is a deforming non-erosive arthropathy characterized by ulnar deviation of the second to fifth fingers with metacarpophalangeal joint subluxation that is correctable with physical manipulation1. It was traditionally described as occurring post-rheumatic fever but also seen in association with systemic lupus erythematosus, psoriatic arthritis, inflammatory bowel disease and malignancy2. It is thought to be related to ligamentous laxity. It typically affects themetacarpophalangeal joints but can also affect the proximal interphalangeal joints of the hands, wrists and knees3. Hand radiographs typically show marked ulnar subluxation and deviation atthe metacarpophalangeal joints with absence of erosions. We present a case in a very youngfemale with no prior history of rheumatic fever or acute arthritis at any stage of illness.

20 Years of Radiographic Imaging: Crystalline Deposits Causing Severe Arthropathy and Erosions

ABSTRACT Urate crystal gout arthritis and calcium pyrophosphate deposition disease (CPPD) are crystalline arthropathies seen in middle age to elderly patients, but are also seen in the active duty military population. Flares of either can be identified by acute joint pain, associated swelling, tenderness, and warmth. Definitive diagnosis involves synovial analysis from arthrocentesis. Gout and CPPD are common inflammatory joint diseases. Both arthropathies presenting themselves in the same joint are rather rare. An elderly female with a history of gout presented to the hospital with severe hip pain. She was on urate-lowering therapy at the time, and uric acid levels on admission were not significantly elevated. Radiographic imaging of her hip demonstrated periarticular cartilage calcifications. A review of radiographic imaging over the last 20 years found significant erosive arthropathy in multiple joints and radiographic evidence of chondrocalcinosis, suggesting CPPD. Synovial analysis was not obtained during this admission as the patient declined procedures due to her elderly age. Her condition improved with oral steroids. Few literatures have demonstrated that gout and CPPD are common crystal arthropathies that can occur concomitantly in the same joint. A 20-year review of imaging in an elderly female with known gout arthropathy found that she had radiographic evidence of concomitant CPPD-associated damage to many of her joints. Clinicians should be aware of the different erosive arthropathies, their corresponding imaging findings, evaluation for underlying metabolic disorders if appropriate, and the possibility that they may occur in the same joint. Early prevention can reduce joint destruction later in life.

Synovial Chondromatosis

Chapter 67 discusses synovial chondromatosis, which is a neoplastic process that can lead to a monoarticular erosive arthropathy. It is divided into primary and secondary forms, and this chapter focuses on primary synovial chondromatosis. It can occur in joints, bursae and tendon sheaths, and can be calcified or noncalcified. The knee and hip are the most commonly involved joints. Pathologically, there is subsynovial hypertrophy with cartilaginous nodules. These cartilaginous bodies can detach and may calcify and ossify. The pathophysiology, epidemiology and treatment are discussed, and the imaging features of this disease on radiographs, CT, and MRI are described.

Ultrasound in the assessment of musculoskeletal involvement in systemic lupus erythematosus: state of the art and perspectives

Musculoskeletal manifestations are extremely common in patients with systemic lupus erythematosus. Transient and migratory arthralgia is frequently reported even without clinical signs of joint or tendon inflammation. In less than 15% of patients, joints may be more severely affected by deforming (Jaccoud's arthropathy) and/or erosive arthropathy (Rhupus syndrome). In recent years, ultrasound has emerged as a promising imaging technique for the assessment of musculoskeletal involvement in systemic lupus erythematosus, having demonstrated the ability to detect inflammation and structural damage both at articular and periarticular level. Recent ultrasound studies have also revealed new insights into musculoskeletal involvement in patients with systemic lupus erythematosus, some of them questioning the traditional concepts of systemic lupus erythematosus arthropathy, with potential clinical, prognostic and therapeutic implications. In daily clinical practice, the use of ultrasound in the assessment of joint and tendon involvement in patients with systemic lupus erythematosus is still limited. Several methodological issues encountered in ultrasound studies evaluating musculoskeletal involvement in systemic lupus erythematosus patients need to be addressed in order to improve both the reliability and clinical usefulness of ultrasound findings. This paper reviews ultrasound studies assessing musculoskeletal involvement in patients with systemic lupus erythematosus, highlighting certainty, limits, potential applications and future perspectives of ultrasound use in systemic lupus erythematosus patients.

Rheumatoid arthritis presenting as rheumatoid meningitis

Rheumatoid meningitis (RM) is a rare extra-articular manifestation of rheumatoid arthritis (RA). A 59-year-old man presented with a 10-day history of right-sided frontal headache and a 7-day history of subacute left-sided weakness. He had no history of RA. He was febrile (38.2°C). Left ankle dorsiflexion and plantarflexion were graded at 4+/5. He developed focal onset motor seizures. He was intermittently febrile with minimal improvement despite intravenous antivirals and antimicrobials. Serology revealed elevated rheumatoid factor 88.2 IU/mL and anti-cyclic citrullinated peptide (anti-CCP) IgG >340 AU/mL. Initial cerebrospinal fluid (CSF) was predominantly lymphocytic 96%, with elevated protein 672 mg/L and normal glucose 3.4 mmol/L. Interval CSF revealed newly low glucose 2.6 mmol/L. Extensive CSF microbiology tests were negative. CSF cytology confirmed reactive lymphocytes. MRI brain revealed right frontoparietal leptomeningeal enhancement. Brain and leptomeningeal biopsy demonstrated florid leptomeningeal mixed inflammatory infiltrate without granulomas. The combination of elevated anti-CCP IgG, erosive arthropathy, CSF lymphocytosis, asymmetrical leptomeningeal enhancement and biopsy findings confirmed RM.

A possible case of mycetoma in ancient Rome (Italy, 2nd-3rd centuries AD)

Reports of historical individuals with mycetoma are anecdotal in the palaeopathology literature, particularly in more temperate areas of the world. This article details a probable case of mycetoma in Imperial-era Rome, Italy. Differential diagnoses of leprosy, erosive arthropathy, sarcoidosis, and mycoses are considered. Given the morphology and pattern of the lower leg lesions and the ecology of the disease, the authors conclude that mycetoma is the most likely explanation.