(Kiosk 2) Getting out of Hand, Jaccoud Arthropathy: A Case Report

Case Diagnosis: Jaccoud Arthropathy (JA)

Case Description or Program Description: A 60-year-old African American male presents with difficulty using his hands, tying his shoes, grasping objects, opening/closing buttons, and grooming. On physical exam, he cannot extend his fingers or make fists and has significant ulnar deviation of his bilateral hands. XRay was ordered, and the patient was referred to Orthopedic Surgery and Rheumatology.

Setting: Veterans’ Hospital clinic

Assessment/Results: XRays shows stable, multifocal ulnar deviation of the metacarpophalangeal joints bilaterally; extension deformity at the proximal interphalangeal joints of the third through fifth digits bilaterally; mild subluxation at the left carpometacarpal joint; and nonerosive deformities of the joints. After further workup, Rheumatology ruled out more common etiologies of joint deformities, including autoimmune disorders. Based on these data, the patient was diagnosed with Jaccoud’s Arthropathy (JA). The patient was prescribed occupational therapy, focusing particularly on fine motor skills, self-feeding, showering, and range of motion exercises. Orthopedic Surgery agreed with conservative management.

Discussion (relevance): Jaccoud’s Arthropathy (JA) is a rare form of arthritis that can lead to reducible deformities of the hands and feet, which are different from those in Rheumatoid Arthritis (RA), the diagnosis it is most commonly mistaken for. Classical deformities in JA include: thumb subluxation, swan neck, ulnar deviation, and boutonniere, which are not present in RA, as well as reducibility to passive movement and lack of joint erosions on plain radiographs. JA is found to often be associated with lupus, connective tissue disorders, polymyositis, Sjogrens, and vasculitis, and is even less frequently found in otherwise healthy individuals.

Conclusions: It is important to consider rare pathologies when assessing patients with joint deformities and consequential functional impairments, in order to appropriately diagnose and treat. It is essential to perform a thorough joint exam, particularly in the case of JA, and carefully assess radiographic images to differentiate it from RA.