Jaccoud's arthritis. A case report.

A woman admitted for cardiac catheterization was found to have chronic arthritis of both hands. She gave a history ofmany recurrent attacks of rheumatic fever with gradual development of her joint deformity. On further study, these changes were found to consist of marked ulnar deviation of the fingers at the matacarpophalangeal joints and hyperextension of the proximal interphalangeal joints of the 2nd, 3rd, 4th, and 5th digits unaccompanied by clinical evidence of bone destruction. Serological tests for rheumatoid factors were negative and the patient had a normal erythrocyte sedimentation rate. Her catheterization data showed severe aortic stenosis. The above results conform to the criteria outlined by Jaccoud (1869) as necessary for the diagnosis of chronic post rheumatic fever arthritis. The relationship of chronic deforming arthritis and valvular heart disease is complex and has been the source of a large number of investigations both clinical and pathological. It is now apparent that rheumatic fever is a late non-suppurative complication of Group A streptococcal infection manifested clinically by many symptoms (Master, 1944; Massell and Jones, 1944; Hubble, 1943), the most typical of which is migratory polyarthritis. Permanent joint deformity is not one of the criteria used in the diagnosis of rheumatic fever (Duckett Jones, 1944). Rheumatoid arthritis may also present as an acute febrile polyarthritis but is not usually associated with streptococcal infection. A distinction between the two varieties of arthritis may be made