[Atypical arthritis of the hands : Collagenosis-part 1]

Abstract

Background: Systemic lupus erythematosus (SLE) is a gynecotropic autoimmune vasculitis with manifestations in various organ systems including the skin, internal organs, and joints.

Objective: Presentation of the atypical arthritis patterns of the hands in SLE as the most common autoimmunologic rheumatologic disease from the group of collagenoses in the context of clinical and serological findings and considering the classification criteria of the American College of Rheumatology compared to rheumatoid arthritis (RA) and psoriatic arthritis (PsA).

Materials and methods: Narrative review based on the current literature on the subject from a radiological and rheumatological point of view.

Results: In 80-90% of all SLE cases, hand joint manifestations can be detected, mostly in the form of non-erosive oligo- or polyarthralgias with the picture of so-called luxation arthropathies and with the pattern of a so-called Jaccoud's or Lupus' syndrome, which are accompanied by "carpal instability" in 15% of cases. In association with an antiphospholipid antibody syndrome, ischemic osteonecrosis may occur in 5-50% of SLE, predominantly in weight-bearing areas of the skeleton, and less frequently in the carpal bones or metacarpal heads. The rare rhupus syndrome comprises patients with overlap of RA and SLE features.

Conclusions: Due to the heterogeneity of the symptoms and the often individually very different courses, the diagnosis of SLE can be difficult. Since new drug therapy concepts have significantly increased the 5‑year survival rates of SLE from 0% in the 1950s to 70-90% in recent decades, a timely and definite diagnosis is necessary, to which radiologists can also contribute by correctly classifying the image morphological SLE arthritis patterns in the hands.

Keywords: Hand arthritis patterns; Jaccoud’s syndrome; Lupus syndrome; Luxation arthropathy; Systemic lupus erythematosus.