Case report: Joint deformity associated with systemic lupus erythematosus

Area of Science:

• Rheumatology
• Immunology
• Radiology

Background:

• Jaccoud arthropathy (JA) is a rare, non-erosive joint deformity. Its distinction from rhupus syndrome, which involves bone erosion, remains debated.
• Diagnostic criteria for JA are not unified, complicating its accurate identification and management.

Observation:

• A 27-year-old woman with a 5-year history of systemic lupus erythematosus (SLE) and lupus nephritis presented with progressive hand and foot deformities.
• Clinical examination revealed elevated inflammatory markers and positive autoantibodies (ANA, anti-dsDNA, anti-ENA) with low complement levels.
• Radiographic and MRI studies showed no evidence of bone erosion, consistent with JA.

Findings:

• The patient was diagnosed with SLE-complicated JA without bone erosion.
• A treatment regimen including prednisone, tofacitinib, methotrexate, and celecoxib resulted in significant improvement of joint symptoms.
• No disease progression was noted during a 4-month follow-up.

Implications:

• This case suggests that JA can occur in SLE patients without bone erosion, challenging the traditional definition.
• Bone erosion may be a critical differentiator between JA and rhupus syndrome, requiring further investigation.
• Combination therapy with prednisone, tofacitinib, methotrexate, and celecoxib appears to be a promising treatment strategy for JA.