DEFORMING ARTHROPATHY OR LUPUS AND RHUPUS HANDS IN SYSTEMIC LUPUS-ERYTHEMATOSUS

Objective-Although deforming arthropathy in systemic lupus erythematos us (SLE) is characterised by a number of manifestations, definitive cr iteria for the different forms have not yet been established. To defin e deforming arthropathy and its different types a study was undertaken of 176 SLE patients. Methods-Using as criterion any deviation from an y of the metacarpus finger axes 17 patients (16 women, one man) were i dentified with clinical deforming arthropathy. These patients were eva luated according to a standardised protocol that covered all known cha racteristics of deforming arthropathy. By means of ''Jaccoud's arthrop athy index'' three different forms were identified. Results-Three pati ents had an erosive form of deforming arthropathy (or rhupus hand) suc h as those seen in frank rheumatoid arthritis (RA), eight patients wer e identified as having Jaccoud's arthropathy (or lupus hand), and the remaining six patients had mild deforming arthropathy. Jaccoud's arthr opathy is characterised by severe deformation of the hands (ulnar devi ation, swan neck deformities, and Z deformity of the thumb) and feet w ith multiple non-erosive subluxations, mild aching and little or no ev idence of synovitis. All patients, but one, fulfilled just four criter ia of the ACR classification and joint symptoms were always found to p recede the diagnosis of SLE. Furthermore a remarkable association of J accoud's arthropathy with fetal loss, thrombosis-both venous and arter ial-and the presence of antiphospholipid antibodies was found. Conclus ions-These data suggest that Jaccoud's arthropathy represents a subset of SLE. Subdivision of deforming arthropathy into several clinical fo rms can facilitate the clinical management of this disorder.