Lupus arthropathy in the hands and wrists

Case contributed by Dr Matt A. Morgan

Presentation

Pain in the hands and wrists. History of a chronic connective tissue disorder.

Patient Data

Age: 45 years
Gender: Female

Hand/wrist series

x_ray

Radiographs of the hands, including Norgaard (ball-catcher's) views. There are multiple typical findings in SLE arthropathy, including

  • marked contractures and subluxations in a bilateral symmetric pattern
  • swan neck deformities, particularly in the right hand
  • hooked heads of the second and third metacarpals
  • juxta-articular osteopenia
  • no erosions
  • no soft tissue calcifications

Case Discussion

Systemic lupus erythematosus (SLE or just "lupus") is a connective tissue disorder that can result in multiple musculoskeletal abnormalities, including a characteristic arthropathy in the hands (sometimes called "lupus arthritis").

The joints are affected in this systemic disease in 75-90% of patients and radiographic changes include:

  • subluxation/dislocation
  • absence of erosions or loss of joint space
  • bilateral and symmetric changes
  • juxta-articular osteopenia

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