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Jaccoud's Arthropathy in Gout: An Unusual Association.

Donato Alves T, Oliveira IS, Fadul LC, Santiago MB - Case Rep Rheumatol (2014)

Bottom Line: Jaccoud's arthropathy (JA) is a deforming arthropathy observed mainly in patients with systemic lupus erythematosus.He presented deformities typical of JA and subcutaneous nodules.To our knowledge, this is the first report of JA secondary to chronic gout.

View Article: PubMed Central - PubMed

Affiliation: Universidade Federal da Bahia, Rua Augusto Viana s/n, Canela, 40110-060 Salvador, BA, Brazil.

ABSTRACT
Jaccoud's arthropathy (JA) is a deforming arthropathy observed mainly in patients with systemic lupus erythematosus. We report the case of a 41-year-old Brazilian man with a 10-year history of intermittent monoarthritis followed by bouts of polyarthritis affecting large and small joints. He presented deformities typical of JA and subcutaneous nodules. Histopathological findings of a nodule biopsy were consistent with gouty tophi. To our knowledge, this is the first report of JA secondary to chronic gout.

No MeSH data available.


Related in: MedlinePlus

Histopathological findings of the subcutaneous nodule: foreign body cell reaction to eosinophilic fibrillar material consistent with gouty tophi (arrow). In the peripheral area, there is an inflammatory infiltrate of lymphocytes, plasma cells, and macrophages (arrowhead) (hematoxylin and eosin 100x).
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fig3: Histopathological findings of the subcutaneous nodule: foreign body cell reaction to eosinophilic fibrillar material consistent with gouty tophi (arrow). In the peripheral area, there is an inflammatory infiltrate of lymphocytes, plasma cells, and macrophages (arrowhead) (hematoxylin and eosin 100x).

Mentions: The patient was a 41-year-old Brazilian mulatto male with a 10-year history of episodic arthritis and concomitant systemic arterial hypertension controlled with losartan 50 mg/daily. Arthritis initially affected the first right metatarsophalangeal joint followed by progressive involvement of other joints. During the past 5 years, he has experienced polyarthritis outbreaks affecting large and small joints associated with low-grade fever, but not morning stiffness. The most recent outbreak prompted his hospitalization at our institution. On admission, physical examination revealed a good general demeanor, low-grade fever of 37.8°C, and blood pressure of 130/80 mm/Hg. We did not identify abnormalities during the cardiorespiratory evaluation or hepatosplenomegaly on abdominal palpation. On musculoskeletal examination, we identified swan-neck deformity of the fingers that was reversible with passive movement (Figure 1). Additionally, ankles, knees, and elbows appeared swollen and felt warm to the touch. He had painless subcutaneous nodules of fibrous consistency and different sizes (0.5 to 1 cm) on the extensor surfaces of the forearms and legs. Laboratory tests results indicated hemoglobin of 8.5 g/dL, white blood cell count 12700 cells/mm3, and uricemia in the upper normal range (6.7 mg/dL), and he had normal glycemia, total cholesterol, creatinine, and hepatic enzymes. Acute phase reactants, including erythrocyte sedimentation rate and C-reactive protein, were 62 mm and 418 mg/L, respectively. Anti-CCP antibodies by ELISA were low-positive (38 U), with a negative cutoff value of <20 U. Antinuclear antibodies, rheumatoid factor, anti-dsDNA, and anti-SSA/Ro antibodies were negative. Plain radiographs of the hand were normal with no evidence of bone erosions (Figure 2). Biopsy of a subcutaneous nodule was performed and the histopathological findings were consistent with gouty tophi (Figure 3). The patient began treatment with prednisone 40 mg/daily and colchicine 1 mg/daily with progressive improvement of symptoms and normalization of acute phase reactants. During subsequent follow-ups at the outpatient clinic, he was tapered off prednisone and continued to receive maintenance treatment with colchicine; then, allopurinol was added to it. After approximately 1 year of follow-up, he is doing well, is receiving treatment with allopurinol only (300 mg/day), and has no complaints of joint pain or swelling.


Jaccoud's Arthropathy in Gout: An Unusual Association.

Donato Alves T, Oliveira IS, Fadul LC, Santiago MB - Case Rep Rheumatol (2014)

Histopathological findings of the subcutaneous nodule: foreign body cell reaction to eosinophilic fibrillar material consistent with gouty tophi (arrow). In the peripheral area, there is an inflammatory infiltrate of lymphocytes, plasma cells, and macrophages (arrowhead) (hematoxylin and eosin 100x).
© Copyright Policy - open-access
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4150410&req=5

fig3: Histopathological findings of the subcutaneous nodule: foreign body cell reaction to eosinophilic fibrillar material consistent with gouty tophi (arrow). In the peripheral area, there is an inflammatory infiltrate of lymphocytes, plasma cells, and macrophages (arrowhead) (hematoxylin and eosin 100x).
Mentions: The patient was a 41-year-old Brazilian mulatto male with a 10-year history of episodic arthritis and concomitant systemic arterial hypertension controlled with losartan 50 mg/daily. Arthritis initially affected the first right metatarsophalangeal joint followed by progressive involvement of other joints. During the past 5 years, he has experienced polyarthritis outbreaks affecting large and small joints associated with low-grade fever, but not morning stiffness. The most recent outbreak prompted his hospitalization at our institution. On admission, physical examination revealed a good general demeanor, low-grade fever of 37.8°C, and blood pressure of 130/80 mm/Hg. We did not identify abnormalities during the cardiorespiratory evaluation or hepatosplenomegaly on abdominal palpation. On musculoskeletal examination, we identified swan-neck deformity of the fingers that was reversible with passive movement (Figure 1). Additionally, ankles, knees, and elbows appeared swollen and felt warm to the touch. He had painless subcutaneous nodules of fibrous consistency and different sizes (0.5 to 1 cm) on the extensor surfaces of the forearms and legs. Laboratory tests results indicated hemoglobin of 8.5 g/dL, white blood cell count 12700 cells/mm3, and uricemia in the upper normal range (6.7 mg/dL), and he had normal glycemia, total cholesterol, creatinine, and hepatic enzymes. Acute phase reactants, including erythrocyte sedimentation rate and C-reactive protein, were 62 mm and 418 mg/L, respectively. Anti-CCP antibodies by ELISA were low-positive (38 U), with a negative cutoff value of <20 U. Antinuclear antibodies, rheumatoid factor, anti-dsDNA, and anti-SSA/Ro antibodies were negative. Plain radiographs of the hand were normal with no evidence of bone erosions (Figure 2). Biopsy of a subcutaneous nodule was performed and the histopathological findings were consistent with gouty tophi (Figure 3). The patient began treatment with prednisone 40 mg/daily and colchicine 1 mg/daily with progressive improvement of symptoms and normalization of acute phase reactants. During subsequent follow-ups at the outpatient clinic, he was tapered off prednisone and continued to receive maintenance treatment with colchicine; then, allopurinol was added to it. After approximately 1 year of follow-up, he is doing well, is receiving treatment with allopurinol only (300 mg/day), and has no complaints of joint pain or swelling.

Bottom Line: Jaccoud's arthropathy (JA) is a deforming arthropathy observed mainly in patients with systemic lupus erythematosus.He presented deformities typical of JA and subcutaneous nodules.To our knowledge, this is the first report of JA secondary to chronic gout.

View Article: PubMed Central - PubMed

Affiliation: Universidade Federal da Bahia, Rua Augusto Viana s/n, Canela, 40110-060 Salvador, BA, Brazil.

ABSTRACT
Jaccoud's arthropathy (JA) is a deforming arthropathy observed mainly in patients with systemic lupus erythematosus. We report the case of a 41-year-old Brazilian man with a 10-year history of intermittent monoarthritis followed by bouts of polyarthritis affecting large and small joints. He presented deformities typical of JA and subcutaneous nodules. Histopathological findings of a nodule biopsy were consistent with gouty tophi. To our knowledge, this is the first report of JA secondary to chronic gout.

No MeSH data available.


Related in: MedlinePlus