Sanchez Rafael, Vala Lovekumar, Dhadhal Riya, Frontela Odalys, Aldrich Jose
Department of Internal Medicine, Larkin Community Hospital Palm Springs Campus, Hialeah, USA.
Department of Internal Medicine, Shantabaa Medical College, Amreli, IND.
Cureus. 2024 Aug 26;16(8):e67864. doi: 10.7759/cureus.67864. eCollection 2024 Aug.
Jaccoud's arthropathy (JA) is a chronic deforming arthropathy, initially linked to rheumatic fever, now more commonly associated with systemic lupus erythematosus (SLE). We report a case of a 27-year-old male presenting with a four-month history of joint pain in the bilateral hands and feet, accompanied by stiffness but no swelling, erythema, or fever. Physical examination revealed flexion deformities, ulnar deviation at the metacarpophalangeal joints, and hyperextension at the proximal interphalangeal joints, without tenderness. Laboratory findings showed elevated anti-double stranded DNA (anti-dsDNA) antibodies and positive antinuclear antibodies (ANA), and imaging confirmed non-erosive arthropathy. Diagnosed with SLE-associated JA, the patient was treated with prednisone, diclofenac, and hydroxychloroquine, leading to significant symptom improvement and decreased anti-dsDNA antibody levels. Even though non-erosive and non-deforming arthropathy is more commonly seen in SLE, timely identification of JA as a non-erosive but deforming arthritis is crucial in differentiating SLE from rheumatoid arthritis. This case underscores the need for comprehensive evaluation and tailored therapy in complex autoimmune conditions to prevent long-term joint damage and improve patient outcomes.
雅库病(JA)是一种慢性变形性关节病,最初与风湿热有关,现在更常见于系统性红斑狼疮(SLE)。我们报告一例27岁男性病例,其双手和双脚关节疼痛4个月,伴有僵硬,但无肿胀、红斑或发热。体格检查发现有屈曲畸形、掌指关节尺侧偏斜和近端指间关节过伸,无压痛。实验室检查结果显示抗双链DNA(抗dsDNA)抗体升高,抗核抗体(ANA)阳性,影像学检查证实为非侵蚀性关节病。该患者被诊断为SLE相关的JA,接受了泼尼松、双氯芬酸和羟氯喹治疗,症状明显改善,抗dsDNA抗体水平下降。尽管非侵蚀性和非变形性关节病在SLE中更常见,但及时将JA识别为非侵蚀性但变形性关节炎对于区分SLE和类风湿关节炎至关重要。该病例强调了在复杂的自身免疫性疾病中进行全面评估和个体化治疗以防止长期关节损伤并改善患者预后的必要性。