Concerns with a case of Jaccoud arthropathy/The authors respond

• Published in: The Journal of musculoskeletal medicine Vol. 25; no. 1; p. 9
• Main Authors: Kaushik, Prashant, Kaushik, Richa, Pappu, Ramesh, Adenwalla, Humaira N
• Format: Journal Article
• Language: English
• Published: Darien MultiMedia Healthcare Inc 01.01.2008
• ISSN: 0899-2517

Diagnostic dilemmas remain a challenge in rheumatology, and the insightful points brought forth for discussion are greatly appreciated. We agree that the description of hook-like osteophytes versus erosions may be confusing and, as in this case, interchangeable. The patient's liver function test results were normal, although genetic testing for hemochromatosis was never carried out. The patient's workups for HIV and systemic lupus erythematosus also showed normal results. We are in agreement on the valid point about etanercept; it was discontinued as care of the patient was assumed from another rheumatologist. With regard to the final point, the patient's occupation made it extremely difficult to wean him off low-dose prednisone. A number of NSAIDs were tried in the attempt to manage his symptoms related to mechanical pain, but none had succeeded. The authors did not discuss the diagnostic implication of the "hook" erosions (osteophytes?) at the second and third metacarpophalangeal (MGP) joints seen on the radiographs of the patient's hands. Seeing them on the radial aspect of the second and third MGP joints in a middle-aged white man, as is the case in the authors' report, should prompt a clinician - more so a rheumatologist -to suspect hemochromatosisrelated arthropathy rather than Jaccoud arthropathy.1