CLINICAL VIGNETTE |
Anti-Jo-1 antibody-positive arthropathy presenting as severe osteolysis of the distal interphalangeal joints
Correspondence to: M. Yamamoto. E-mail: mocha{at}cocoa.plala.or.jp
A 66-yr-old housewife developed arthralgia of the shoulders, hands and fingers with Raynaud's phenomenon from 1996. She recognized swelling of the finger joints, dry cough and dyspnoea on exertion in 1998. Arthralgia subsequently disappeared but deformities of the DIPs remained. The patient attended a consultation at our hospital for breathlessness and joint deformities in 2001.
Severe interstitial pneumonia was identified on chest radiography and CT. However, 67Ga scintigraphy showed no uptake in the lungs. Radiography of the hands revealed joint destruction in the interphalangeal joints and DIPs. Severe marginal erosion of the sides of the middle phalanges and proximal ends of the distal phalanges was recognized. Dislocations of DIPs had resulted from these bone changes (the figure shows radiographs of the patients’ hands).
No abnormalities were apparent in other joints. Signal uptake on 99mTc bone scintigraphy was recognized only in the DIPs. Fat-suppression gadolinium-enhanced MRI of the hands revealed no proliferation of synovium or accumulation of joint fluid.
Laboratory data on admission revealed normal biochemistry. Negative results were obtained for CRP, RF and ANA. However, anti-Jo-1 antibodies were detected in serum.
No treatment was prescribed, as active arthritis and interstitial pneumonia were not present. Two years later, joint symptoms and lung function have not deteriorated.
We, the authors, declare that there are no conflicts of interest.
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