Jaccoud's arthropathy in the elderly
Jaccoud's arthropathy in the elderly
复制标题
老年人雅库德关节病
DOI：
10.1093/rheumatology/keab770
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发表时间：
2022
期刊：
影响因子：
5.5
通讯作者：
Terada Y
中科院分区：
文献类型：
--
作者：
Horino T;Ueba H;Inotani S;Izumi M;Ichii O;Terada Y
患者为一名73岁女性，有20年的手部疼痛病史，归因于OA。除高血压和骨质疏松症外，患者无显著病史。实验室检查未发现明显异常。CRP和MMP-3水平在正常范围内。血清RF、ANA、抗CCP抗体、抗Ro/SSA抗体、抗dsDNA抗体、抗Sm抗体、抗RNP抗体均为阴性。手的DIP和PIP关节严重变形;大多数关节可复位（图1A）。手和腕关节的X线片显示IP关节严重脱位和半脱位，掌骨和腕关节关节面下有多处轻度糜烂性病变（图1B）。Jaccoud关节病首先在风湿热和SLE患者中报道[1]。贾库德关节病也出现在许多疾病中，包括其他结缔组织疾病、感染和肿瘤[1]。它也发生没有任何相关的疾病，一种形式被称为“特发性”，或在老年人群中，作为“衰老”[1，2]。Jaccoud关节病的关节畸形是由肌腱和韧带松弛引起的。Jaccoud关节病由于相似的临床特征经常被误诊为RA [1]。在该患者中，与关节软骨表面接触的骨表面由于半脱位而变形，并且由于关节炎诱导的脆性，骨变形以承受机械压力。在这个病人中，关节融合术减轻了症状。在老年人中，Jaccoud关节病可能由于骨骼和关节支持组织的老化相关脆弱性而发生。临床医生应注意不要将其误诊为RA。
The patient, a 73-year-old woman, presented with a 20-year history of pain in the hands that had been attributed to OA. The patient had no significant medical history except for hypertension and osteoporosis. Laboratory examination revealed no remarkable findings. CRP and MMP-3 levels were within normal. Serological tests including RF, ANA, anti–CCP antibody, anti-Ro/SSA antibody, anti-dsDNA antibody, anti-Sm antibody and anti-RNP antibody were negative. The DIP and PIP joints of the hands were severely deformed; most of the joints were reducible (Fig. 1A). Radiography of the hands and wrists showed severe luxation and subluxation of the IP joints and multiple mild erosive lesions below the articular surfaces of the metacarpal and wrist joints (Fig. 1B).Jaccoud’s arthropathy was first reported in patients with rheumatic fever and SLE [1]. Jaccoud’s arthropathy is also found in many diseases, including other CTDs, infections and neoplasia [1]. It also occurs without any associated diseases, a form referred to as ‘idiopathic’or, in the elderly population, as ‘senescent’[1, 2]. Joint deformity of Jaccoud’s arthropathy is caused by tendon and ligament laxity. Jaccoud’s arthropathy is often misdiagnosed as RA due to similar clinical features [1]. In this patient, the bone surfaces in contact with the articular cartilage surface were deformed due to subluxation, and the bones were deformed to withstand mechanical pressure due to osteoporosis-induced fragility. In this patient, arthrodesis reduced the symptoms. In the elderly, Jaccoud’s arthropathy could occur due to agingrelated fragility of the bones and joint supporting tissues. Clinicians should be careful not to misdiagnose it as RA.