Age / Sex : 27 / F

Deforming nonerosive arthropathy (Jaccoud arthropathy)

Discussion

Findings:

Ulnar subluxation/dislocation and deviation at the MCP joints

Severe hallux valgus, subluxation/dislocation at 1^st MTP joints

Lt talonavicular dislocation

Absence of bone erosions

Differential Diagnosis:

Rheumatoid arthritis

Diagnosis:  

Deforming nonerosive arthropathy (Jaccoud arthropathy)

Discussion:

Jaccoud’s arthropathy appears to result from capsular inflammation and fibrosis. It may occur in association with systemic lupus erythematosus and scleroderma, as well as with rheumatic fever. Symptomless and reversible joint deformities become evident, particularly in the hands but also in the feet. Typically, ulnar deviation and flexion deformities are apparent at the metacarpophalangeal joints, predominantly in the fourth and fifth digits, and may be combined with hyperextension at the interphalangeal joints. In the foot, fibular deviation and subluxation at the metatarsophalangeal joints may be observed. Associated abnormalities in the foot include hallux valgus, and widening of the forefoot. Instability in the knee or shoulder has also been encountered. In the hands and feet, the reversible nature of the articular deformity is striking. During radiography, pressing the hand against the cassette may result in an entirely normal posteroanterior radiograph. In some instances, chronic fixed deformities can appear. In most patients, articular space narrowing and osseous erosions are not evident, thereby allowing the differentiation of Jaccoud’s arthropathy from rheumatoid arthritis and other inflammatory synovial processes. Occasionally, however, articular space diminution is encountered; this probably represents cartilaginous atrophy caused by disuse and cartilaginous erosion secondary to closely applied subluxed osseous surfaces. Hook erosions on the radial and palmar aspects of the metacarpal heads, which can appear in Jaccoud’s arthropathy, superficially resemble the marginal erosions of rheumatoid arthritis. Deforming nonerosive arthropathy (Jaccoud arthropathy).

References:

Bone and Joint Imaging, 3^rd edition, Resnick, Kransdorf