Clinical Images: Jaccoud arthropathy in a patient with Crohn disease

The patient, a 46-year-old man with a 10-year history of Crohn disease status post ileostomy, was incidentally noted to have deformities of the small joints of both hands. He reported intermittent stiffness and mild discomfort without joint swelling, erythema, or prolonged morning stiffness. (A) Physical examination showed hyperextension of the proximal interphalangeal joints (green arrow) and flexion of the distal interphalangeal joints (yellow arrow), resulting in an “S”-shaped deformity. Laboratory evaluation showed negative antinuclear antibody, rheumatoid factor <10 IU/mL, negative anti–cyclic citrullinated peptide, anti–double-stranded DNA antibodies, and normal complement levels. Hand radiographs (B) did not show erosion or joint space narrowing (green arrows) but (C) did show swan-neck deformity (green arrow). These findings are consistent with Jaccoud arthropathy, a chronic nonerosive deforming arthropathy resulting from periarticular soft-tissue involvement rather than destructive synovitis. The patient was managed conservatively with splinting and range-of-motion exercises, with stable hand function on follow-up. Disclosure form. Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.