Jaccoud-type lupus arthropathy: practical classification criteria.

Abstract

To the Editor, In 1869, Francois-Sigismond Jaccoud1 described a young patient with rheumatic fever (RF) and chronic joint deformities. As homage to this physician, these deformities are known as Jaccoud’s arthropathy (JA). Classical deformities observed in JA, such as swan neck, thumb subluxation, ulnar deviation and ‘ boutonniere ’, are similar to those seen in rheumatoid arthritis (RA) but are characteristically ‘reducible’ to passive movement. Moreover, on plain radiographs, there are no joint erosions. As RF has now become rare, JA has been described in association with several other disorders, particularly SLE. Although less common, it has also been described in other diffuse connective tissue disorders (DCTDs) such as systemic sclerosis, polymyositis, Sjogren’s syndrome and vasculitis, as well as neoplastic diseases and even in normal individuals. Although a ‘reducible’ pattern of arthropathy is observed in the majority of JA cases, in most advanced cases, the joints may become fixed, sometimes referred as to ‘severe JA’,2 which is clinically difficult to distinguish from RA. In such situations, misdiagnosis is common, with dangerous consequences. Having a set of classification criteria for JA is mandatory for two main reasons, namely: (A) standardising patients …