Systemic (Rheumatic)
SLE Arthropathy (Jaccoud's Arthropathy)
전신홍반루푸스 관절병증
Non-erosive joint deformity in SLE; Jaccoud's arthropathy features reducible deformities
- How common
- 5–35% of SLE patients develop Jaccoud-type
- Typical age
- Ages 15–45, female 9:1
What is it?
Immune-mediated laxity of periarticular ligaments, capsules, and tendons causes deformity while cartilage/bone are spared (no erosions).
Commonly affected: MCP/PIP joints; hip/knee less commonly
How it develops
- Immune Complex DepositionImmune complexes in synovium and peri-articular tissues
- Soft Tissue LaxityLigament/capsule/tendon weakening
- Reducible DeformityUlnar deviation/swan-neck — passively correctable
- Bone/Cartilage PreservationNo erosions on X-ray (vs RA)
Symptoms
- Symmetric polyarthralgiaJoint symptoms in 85–90% of SLE (most common manifestation)
- Reducible deformityUlnar deviation, swan-neck — reduce on extension
- Fatigue/oral ulcersConstitutional symptoms and painless oral ulcers
- Malar (butterfly) rashFixed erythema over malar eminences sparing nasolabial folds
- PhotosensitivityRash and flare after sun exposure
How it is examined
- Reducible deformityUlnar deviation corrects passively to neutral
- Soft tissue swellingPeri-articular swelling; less boggy/tender than RA
- ANA/anti-dsDNA positiveANA >1:160, anti-dsDNA is SLE-specific
- Low complement (C3/C4↓)Marker of active SLE
Imaging
Non-erosive joint deformities; Jaccoud's arthropathy shows reducible deformities without X-ray erosions.
- Normal joint spaces
- No erosions (key RA differentiator)
- Ulnar deviation/swan-neck
- Possible periarticular osteopenia
MRI shows synovitis, tenosynovitis, ligament laxity; marrow edema usually mild.
- Mild synovitis
- Tenosynovitis
- Ligamentous/capsular laxity
- No erosions
Non-surgical care
- HydroxychloroquineFoundation of SLE therapy (improves joints, skin, survival)
- NSAIDs + low-dose steroidsAcute joint symptom control
- ImmunosuppressantsMethotrexate, mycophenolate, azathioprine for severe disease
- BiologicsBelimumab (anti-BLyS), anifrolumab (anti-IFN-I)
Conservative options are generally tried first. Medications listed here can have side effects — discuss them with your prescriber.
When surgery is considered
Rarely indicated; severe functional loss
Procedures that may be discussed
- Soft tissue reconstruction
- Tendon transfer
- Arthrodesis (fix deformity)
Outlook
Joint prognosis good (non-erosive); survival depends on systemic lupus involvement.