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1mediterranean journal 33
of RHEUMATOLOGY 2022
©Ntelis K, Iliopoulos G, Giannopoulos G.
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CASE REPORT
Hands Deformity in a Patient with IgA Vasculitis
Konstantinos Ntelis1, George Iliopoulos2, George Giannopoulos3
1Private Practice, Kalamata, Greece, 2Division of Rheumatology, Department of Internal Medicine, Patras, University Hospital, University of Patras Medical School, Patras, Greece, 3Rheumatology Unit, Alexandra General Hospital, Faculty of Medicine, National and Kapodistrian University of Athens, Athens, Greece
ABSTRACT
74-year-old female patient with IgA vasculitis was referred for rheumatic evaluation due to arthritic complaints and hand deformities. Physical examination revealed reversible Jaccoud's arthropathy in both hands, with swan-neck type deformities, while no erosions were present in the X-Ray. Jaccoud's arthropathy is mainly observed can be present in patients with in Rheumatic Fever, Systemic Lupus Erythematosus, and Sjogren's syndrome. The absence of erosions distinguishes this entity from rheumatoid arthritis. There is no specific treatment other than the treatment of the underlying disease.
Mediterr J Rheumatol 2022;33(2):259-60 https://doi.org/10.31138/mjr.33.2.260
Article Submitted: 21 Feb 2021; Revised Form: 6 Jun 2021; Article Accepted: Jun 30 2021; Available Online: Jun 30 2022
Keywords: IgA vasculitis, Henoch-Schonlein purpura, Jaccoud's arthropathy
ABBREVIATIONS
ANA: Antinuclear antibodies
ANCA: Anti-neutrophil cytoplasmic antibodies
Anti-CCP: Anti-cyclic citrullinated peptide antibodies
IgA: Immunoglobulin A
MCP: Metacarpophalangeal joints
MTP: Metatarsophalangeal joints
RF: Rheumatoid Factor
CASE PRESENTATION
A 74-year-old female patient diagnosed with IgA vasculitis (formerly known as Henoch-Schonlein purpura) was referred by her general practitioner for a rheumatologic evaluation. The diagnosis has been made 12 years ago and was based upon her typical clinical manifestations
(purpura, gastrointestinal bleeding, glo-merulonephritis) and the typical findings in kidney biopsy (dense deposits of IgA immu-nocomplexes and C3 complement).1 The pa-
Figure 1. Arthritis of the right hand with ulnar deviation, swan-neck type deformities in the index and middle finger.
tient had a chronic disease with frequent flares and was under chronic immunosuppressive treatment with steroids and azathioprine by her attending nephrologists. Arthritic complaints were minimal and she has never been referred to a rheumatologist. Main laboratory findings included anaemia (Haematocrit 33%, Hemoglobulin 10.9 gr/dl), elevated serum creatinine (1.72 gr/dl), haematuria (100 red cells per high power field), ANA(-), ANCA(-), RF(-) and anti-CCP(-) . Physical
Corresponding Author:
Konstantinos Ntelis, MD Private Practice, Kalamata, Greece Email: kosdelis@gmail.com Tel: +306975026425
Cite this article as: Ntelis K, Iliopoulos G, Giannopoulos G. Hands Deformity in a Patient with IgA Vasculitis. Mediterr J Rheumatol 259 2022;33(2):259-60.
mediterranean journal
of RHEUMATOLOGY
33 2
2022
Figure 2. X-Ray shows ulnar deviation of both hands, subluxations of the 1st and 5th MCP joints (white arrows), soft tissue enlargement (green arrow) and absence of bone erosions.
examination revealed arthritis in both hands and chronic swan-neck type deformities. The deformities were reversible. Radiographic findings included ulnar deviation, sublaxation of the 1st MCP joints in both hands and absence of joint erosions. This clinical image is typical of Jaccoud's arthropathy.
Jaccoud's arthropathy is mainly observed in Rheumatic Fever, Systemic Lupus Erythematosus and Sjogren's syndrome but has been associated with several clinical entities.2 It is characterised by reversible deformities, usually affecting the MCP and MTP joints. The pathogenesis of the arthropathy is mostly attributed to capsule fibrosis and relaxation of tendons and ligaments. The most characteristic finding in X-rays is the absence of joint erosions, despite the presence of ulnar deviation and swan-neck deformities. This is the major clue for the differential diagnosis between Jaccoud's arthropathy and rheumatoid arthritis. Treatment is mainly conservative and focuses on the underlying disease. To our knowledge this is the first case of Jaccoud's arthropathy associated with IgA vasculitis in literature.
CONFLICT OF INTEREST
The authors declare no conflict of interest.
FUNDING SUPPORT/FINANCIAL BENEFITS
None received in relation to this manuscript.
REFERENCES
1. Audemard-Verger A, Pillebout E, Guillevin L, Thervet E, Terrier B. IgA vasculitis (Henoch-Shonlein purpura) in adults: Diagnostic and therapeutic aspects. Autoimmun Rev 2015;14:579-85.
2. Santiago MB. Jaccoud's arthropathy. Best Pract Res Clin Rheumatol 2011;25:715-25.
