A 50-year-old male presented with a 26-year history of systemic lupus erythematosus. Past features of his disease included pericardial effusions, rash, Raynaud phenomenon, oral ulcers, and arthritis of his hands. His antinuclear antibody test was strongly positive and rheumatoid factor was negative. Examination of his hands revealed deformities resembling swan-neck deformities (Figure 1), however, radiographs showed no erosive changes, consistent with a diagnosis of Jaccoud arthropathy. First described in association with recurrent rheumatic fever, Jaccoud arthropathy may also be seen in chronic rheumatic diseases, particularly systemic lupus erythematosus. It may occur in many joints but is most common in the hands, with features that resemble deformities seen in rheumatoid arthritis and is thought to be because of tendon and ligament laxity with resultant joint instability. It has typically been regarded as a nonerosive arthropathy because plain radiographs do not demonstrate erosions, however, recently this has been called into question with some reported cases showing erosions using more advanced imaging modalities, such as ultrasound and magnetic resonance imaging.
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