Musculoskeletal
Harrison Jordan, DO
Resident Physician
East Carolina University Department of Physical Medicine and Rehabilitation
Greenville, North Carolina, United States
Ryan Jensen, DO
Resident Physician
ECU Health
Greenville, North Carolina, United States
Robert Lombard, MD
Clinical assistant professor
ECU Health
Greenville, North Carolina, United States
Harrison Jordan, DO
East Carolina University Department of Physical Medicine and Rehabilitation
Greenville, North Carolina, United States
A 49-year-old male with a past medical history of chronic pain and Jaccoud's Arthropathy (JA) had been followed by pain management, orthopedic surgery, and rheumatology for the previous seven years, and noted that his symptoms had only worsened. The patient was referred to the pain management clinic by orthopedic surgery with recommendations for a trial of botulinum toxin injections. The patient presented with ulnar deviation of the metacarpals, swan-neck deformities of the 2nd digit, boutonniere deformities of the 3rd-5th digits, and a Z-deformity of the thumb. The patient received botulinum toxin injections in the bilateral flexor digitorum superficialis (FDS), flexor digitorum profundus (FDP), and the lumbricals. The patient followed up in the pain management clinic three months later and reported improvement in pain of the left hand, along with some improvements in range of motion of the digits; however, the patient did note reduced strength in left-hand grip.
JA is a rare non-erosive, deforming arthritis that affects 10-35% of patients with systemic lupus erythematosus. JA classically affects the hands, and patients commonly present with ulnar deviation, swan-neck and boutonnière deformities, non-erosive subluxations, and Z-deformity of the thumb. Conservative treatment options include anti-inflammatory medications, corticosteroids, and methotrexate. There have been minimal studies addressing the management of JA, and no clear guidelines exist. Thus, we present a novel case of botulinum toxin injections for pain relief and functional improvement in a patient with JA.
This case report contributes to the literature for the management of JA, as current treatment guidelines are unclear and studies addressing this condition are urgently needed. Additionally, our case report is unique in demonstrating that botulinum toxin injections could provide pain relief in patients with JA, resulting in analgesic relief and functional improvement.
