open access

Vol 13, No 6 (2018)
Case Reports
Published online: 2018-09-19
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Chronic reversible post-rheumatic fever: Jaccoud’s arthropathy in a 21 year-old male

Santosh Kumar Sinha, Dibbendhu Khanra, Lokendra Rekwal, Puneet Aggarwal, Nishant Kumar Abhishekh, Ramesh Thakur
DOI: 10.5603/FC.a2018.0105
·
Folia Cardiologica 2018;13(6):561-564.

open access

Vol 13, No 6 (2018)
Case Reports
Published online: 2018-09-19

Abstract

Jaccoud’s arthropathy (JA) is a condition characterised clinically by ‘reversible’ joint deformities resulting from soft tissue abnormalities, rather than the destruction of bone joints. Although rare, it has been described in patients with chronic rheumatic heart disease. It typically involves metacarpophalangeal and metatarsophalangeal joints. JA has also been described in systemic lupus erythematosus (SLE), infections and neoplasia. Here, we report the case of a 21 year-old male who had presented with a 16-year history of polyarthralgia, deformities of the hands for the last four years, and a three-year history of exertional palpitation and dyspnoea. Physical examination revealed peripheral signs of aortic run off, with hyperdynamic left ventricle and chronic severe aortic and mitral regurgitation. On examination, gross deformities were noted in both hands in the form of ulnar deviation, swan neck, and ‘z’-thumb, involving interphalangeal joints, metacarpophalangeal and first carpometacarpal joints which were partially correctable. Laboratory investigations ruled out rheumatoid arthritis, SLE, and acute rheumatic fever. Chest X-ray, electrocardiogram and two-dimensional echocardiography and Doppler study were consistent with chronic severe aortic regurgitation and severe mitral regurgitation. Radiographs of both hands showed posterior subluxation of the carpometacarpal joints, which were completely correctable. JA involving a carpometacarpal joint is exceedingly rare.

Abstract

Jaccoud’s arthropathy (JA) is a condition characterised clinically by ‘reversible’ joint deformities resulting from soft tissue abnormalities, rather than the destruction of bone joints. Although rare, it has been described in patients with chronic rheumatic heart disease. It typically involves metacarpophalangeal and metatarsophalangeal joints. JA has also been described in systemic lupus erythematosus (SLE), infections and neoplasia. Here, we report the case of a 21 year-old male who had presented with a 16-year history of polyarthralgia, deformities of the hands for the last four years, and a three-year history of exertional palpitation and dyspnoea. Physical examination revealed peripheral signs of aortic run off, with hyperdynamic left ventricle and chronic severe aortic and mitral regurgitation. On examination, gross deformities were noted in both hands in the form of ulnar deviation, swan neck, and ‘z’-thumb, involving interphalangeal joints, metacarpophalangeal and first carpometacarpal joints which were partially correctable. Laboratory investigations ruled out rheumatoid arthritis, SLE, and acute rheumatic fever. Chest X-ray, electrocardiogram and two-dimensional echocardiography and Doppler study were consistent with chronic severe aortic regurgitation and severe mitral regurgitation. Radiographs of both hands showed posterior subluxation of the carpometacarpal joints, which were completely correctable. JA involving a carpometacarpal joint is exceedingly rare.
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Keywords

Jaccoud’s arthropathy, rheumatic heart disease, metacarpophalangeal joints, carpometacarpal joints, swan neck deformity

About this article
Title

Chronic reversible post-rheumatic fever: Jaccoud’s arthropathy in a 21 year-old male

Journal

Folia Cardiologica

Issue

Vol 13, No 6 (2018)

Pages

561-564

Published online

2018-09-19

DOI

10.5603/FC.a2018.0105

Bibliographic record

Folia Cardiologica 2018;13(6):561-564.

Keywords

Jaccoud’s arthropathy
rheumatic heart disease
metacarpophalangeal joints
carpometacarpal joints
swan neck deformity

Authors

Santosh Kumar Sinha
Dibbendhu Khanra
Lokendra Rekwal
Puneet Aggarwal
Nishant Kumar Abhishekh
Ramesh Thakur

References (12)
  1. Santiago MB. Jaccoud’s arthropathy. Best Pract Res Clin Rheumatol. 2011; 25(5): 715–725.
  2. Moro C, Castro C, Lanza MG, et al. Jaccoud's arthropathy in patients with chronic rheumatic valvular heart disease. Eur J Cardiol. 1978; 6(6): 459–468.
  3. Joseph B, Chacko V. Chronic post-rheumatic-fever arthritis (Jaccoud's arthritis) involving the feet. A case report. J Bone Joint Surg Am. 1984; 66(7): 1124–1125.
  4. Mizutani W, Quismorio FP. Lupus foot: deforming arthropathy of the feet in systemic lupus erythematosus. J Rheumatol. 1984; 11(1): 80–82.
  5. Arlet JB, Pouchot J. The senescent form of Jaccoud arthropathy. J Clin Rheumatol. 2009; 15(3): 151.
  6. Reilly PA, Evison G, McHugh NJ, et al. Arthropathy of hands and feet in systemic lupus erythematosus. J Rheumatol. 1990; 17(6): 777–784.
  7. Aptekar RG, Lawless OJ, Decker JL. Deforming non-erosive arthritis of the hand in systemic lupus erythematosus. Clin Orthop Relat Res. 1974(100): 120–124.
  8. Moro C, Castro C, González Lanza M, et al. [Articular sequelae of rheaumatic fever (Jaccoud's arthropathy)]. Rev Esp Cardiol. 1978; 31(1 Pt 1): 73–78.
  9. Sa RD, Galvao V, Luiz FJ, et al. D’Almeida F, Santiago M. Magnetic resonance imaging of Jaccoud’s arthropathy in systemic lupus erythematosus. Joint Bone Spine. 2010; 77(3): 241–5.
  10. Pastershank SP, Resnick D. "Hook" erosions in Jaccoud's arthropathy. J Can Assoc Radiol. 1980; 31(3): 174–175.
  11. Ignaczak T, Espinoza LR, Kantor OS, et al. Jaccoud arthritis. Arch Intern Med. 1975; 135(4): 577–579.
  12. Murphy WA, Staple TW. Jaccoud's arthropathy reviewed. Am J Roentgenol Radium Ther Nucl Med. 1973; 118(2): 300–307.

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