Jaccoud's arthropathy in systemic lupus erythematosus: clinical, laboratory and ultrasonographic features

Jaccoud's arthropathy (JA) is a deforming, non-erosive arthritis, occurring in 2-35% of systemic lupus erythematosus (SLE) patients. We aimed to evaluate JA patients in a wide monocentric SLE cohort in terms of clinical, serological and ultrasonographic features.

Consecutive SLE patients (ACR criteria 1997) were evaluated. The JA index was applied for patients with reducible deformities. Patients with a JA index ≥5 underwent physical examination, blood testing and ultrasound (US) assessment. Detection of anti-citrullinated protein antibodies (ACPA) and rheumatoid factor (RF) was performed. A single rheumatologist performed the US assessment of bilateral wrist and hands.

Four hundred and eighty SLE patients were evaluated: 17 (3.5%) showed a JA index ≥5 (M:F 1:16; mean age±SD 50.7±11.1 years; mean disease duration±SD 247.8±116.2 months). Four patients (23.5%) showed ACPA positivity. Fifteen patients (88.2%) showed at least one US abnormality. Bone erosions were found in 10 patients (58.8%). ACPA+ve patients showed erosive damage more frequently in at least one joint compared with ACPA-ve (75% vs. 53.8%, p=0.002).

JA should no longer be considered a non-erosive condition since bone damage can occur in more than half of patients. Moreover, the erosive damage seems to be associated with the presence of ACPA.