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Rhumatisme De Jaccoud : Diagnostic Et Prise En Charge. Jaccoud’S Arthropathy : Diagnosis and Therapeutic Management

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Rhumatisme De Jaccoud : Diagnostic Et Prise En Charge. Jaccoud’S Arthropathy : Diagnosis and Therapeutic Management 3 Disponible en ligne sur FMC www.smr.ma Rhumatisme de Jaccoud : diagnostic et prise en charge. Jaccoud’s arthropathy : diagnosis and therapeutic management. Amina Mounir, Akasbi Nessrine, Harzy Taoufik. Service de Rhumatologie, CHU Hassan II, Faculté de médecine et de pharmacie, Université Sidi Mohammeh Ben Abdellah, Fès - Maroc. DOI: 10.24398/A.317.2019 Rev Mar Rhum 2019; 47:3-7 Résumé Abstract Le rhumatisme de Jaccoud (RJ) est une Jaccoud’s arthropathy (JA) is a rare pathologie rare. Il s’agit d’une arthropathie disorder. It is a chronic and non-erosive chronique non érosive touchant deforming arthropathy, usually affecting essentiellement la main. Il s’associe the hands and associated with connective fréquemment aux connectivites notamment tissue disease especially the systemic le lupus érythémateux systémique (LES). Ce lupus erythematosis. This syndrome is syndrome est caractérisé par une déformation characterized by a painless deformity of the indolore et réductible des rayons lunaires II, digits II, III, IV and V with ulnar dislocation III, IV et V avec luxation ulnaire des tendons of extensor tendons in the metacarpal extenseurs dans les vallées métacarpiennes. valleys. The pathophysiology is poorly La physiopathologie est mal connue mais elle known but involves periarticular structures implique les structures périarticulaires telles such as tendons and the joint capsule. The que les tendons et la capsule. La prise en charge clinical management of JA is always aimed du RJ vise toujours à contrôler rapidement at early control of joint inflammation and l’inflammation des articulations et à prévenir une limitation importante des mouvements et preventing severe limitation of movement une perte persistante de la fonction articulaire. and persistent loss of joint function. In this Dans ce topic, on va aborder les particularités subject we will treat the clinical, paraclinical cliniques, paracliniques et thérapeutiques de and therapeutic peculiarities of this cette pathologie. pathology. Mots clés : Rhumatisme de Jaccoud, Key words : Jaccoud’s arthropathy, traitement. treatment. Le RJ est une arthropathie chronique, peu fréquente, des affections diverses, principalement les connectivites. La déformante et non érosive à prédominance acromélique pathogénie n’est pas clairement élucidée mais elle paraît être surtout au niveau des mains, responsable d’une déviation le résultat d’altérations et d’hyperlaxité du système capsulo- en pseudo-coup de vent ulnaire et des doigts en boutonnière ligamentaire. L’objectif du traitement est l’obtention d’une ou en col de cygne. Il peut être idiopathique ou associé à activité inflammatoire la plus minimale possible au niveau Correspondance à adresser à : Dr. A. Mounir Email : [email protected] Revue Marocaine de Rhumatologie 4 FMC A. Mounir, et al. des articulations. Une chirurgie corrective est généralement Description clinique nécessaire en cas de déformations fixes et handicapantes. Le RJ est une arthropathie déformante touchant essentiellement la main avec des déformations similaires PATHOGÉNIE à celles observées au cours de la polyarthrite rhumatoïde Indépendamment de la maladie associée, les mécanismes (PR), à savoir une déviation en pseudo-coup de vent ulnaire étiopathogéniques du RJ reste encore inconnus à ce jour. de la deuxième à la cinquième articulation métacarpo- Les déformations sont la conséquence d’anomalies des phalangienne (MCP), des déformations des doigts en tissus mous incluant la laxité des ligaments et de la capsule boutonnière, en col de cygne et des pouces en Z (figure articulaire, la distension et la déviation secondaire du tendon 1,2). Il peut toucher les membres inférieurs avec des orteils de son axe et la contribution du déséquilibre musculaire. en griffes, hallux valgus et des subluxations métatarso- Le tout est responsable de l’instabilité de l’articulation (1). phalangiennes (MTP) (21). Ces déformations sont indolores, BYWATERS a expliqué que cette maladie évolue en deux phases, en passant d’un rhumatisme disloquant à un non destructrices et typiquement réductibles à l’examen rhumatisme fibreux (2). Une fibrose progressive de la capsule clinique (figure 3). Le malade peut rapporter au début de accompagnée de contractures peut expliquer l’absence de la maladie une sensation de ressaut suite à la subluxation réversibilité des déformations constatées chez les patients ou à la luxation des tendons extenseurs en dedans dans les ayant un RJ anciens (1). La diversité étiologique de ce vallées métacarpiennes lors du passage de l’extension à la rhumatisme pose le problème des liens physiopathologiques flexion (22). Près de 70% des patients souffrent d’arthrite avec la pathologie sous-jacente. Par ailleurs, le RJ a été non déformante, intermittente ou persistante (23,24). également décrit sans aucune maladie associée. Il s’agit d’un RJ appelé «idiopathique» ou une forme «sénescente» chez les personnes âgées (3-5), en rapport probablement avec une dégénérescence du tissu conjonctif de soutien (6). La fréquente atteinte des femmes pourrait être en rapport avec les troubles post-ménopausiques (6). Des études sont nécessaires pour identifier les facteurs prédictifs de survenue d’un RJ et pour mieux comprendre la physiopathologie de cette atteinte. EPIDÉMIOLOGIE La première description du RJ était faite en 1866 par Mr. François-Sigismond Jaccoud (7) chez un jeune adulte de Figure 1 : Déformations réductibles des deux mains en rapport 29 ans présentant un tableau de RAA avec des épisodes avec un rhumatisme de Jaccoud. d’arthrites récurrentes. Mr. Jaccoud le rapporta comme un rhumatisme fibreux succédant à un rhumatisme inflammatoire. Par la suite, le RJ est devenu fréquemment rapporté associé aux connectivites avec des prévalences variables de 10 à 35% des cas dans le lupus systémique (8), 2% dans le syndrome de Sjögren (9), 1% dans la sclérodermie systémique (10) et 21,7% dans le syndrome de chevauchement (11). Plus rarement, il peut se voir dans l’infection par le virus de l’immunodéficience humaine (12), la sarcoïdose (13), la vascularite hypocomplémentémique (14), l’acrodermatite chronique atrophiante (15), la périartérite noueuse (16), le rhumatisme psoriasique Figure 2 : Déformations caractéristiques du rhumatisme (17,18), la chondrocalcinose articulaire (19) et le cancer de Jaccoud au niveau des mains. [N. Akasbi. Médecine du (20). Maghreb. 2014]. Revue Marocaine de Rhumatologie 5 Rhumatisme de Jaccoud : diagnostic et prise en charge. - Négativité ou positivité des réactions sérologiques de la PR. Différents scores de sévérité ont été proposés dont le plus utilisé est l’index d’arthropathie de Jaccoud de Spronk et al (26) qui tient en compte le nombre de doigts atteints et le type de déformation: déviation ulnaire > 20°, déformation en col de cygne, limitation de l’extension des MCP, déformation en boutonnière, déformation en Z. Paraclinique Par définition, le RJ est une arthropathie non associée à des érosions ou de signes de chondrolyse ou de déformation Figure 3 : Réductibilité des déformations des mains en relation en imagerie mais, on peut assister à une déminéralisation avec un rhumatisme de Jaccoud. périarticulaire (27). Après plusieurs années d’évolution, la principale constatation radiologique est la présence de subluxations réversibles. Puis avec le temps, les têtes métacarpiennes peuvent présenter de petites érosions asymétriques, une sclérose marginale et des déformations des métacarpes. Ces érosions peuvent se présenter sous forme de «crochet» ou de «faucille», en particulier au niveau du bord radial (28,29,30) et elles ont été attribuées à une adaptation anatomique face à la tension locale produite par la subluxation progressive des articulations (31). La présence de ces érosions et l’absence d’hypertrophie synoviale sont mieux et plus tôt identifiées par des méthodes d’imagerie plus raffinées telles que l’échographie ou l’imagerie par résonance magnétique (27). En biologie, il n’y a pas de Figure 4 : Radiographie des deux mains face au cours d’une tests diagnostiques spécifiques, bien qu’il soit fréquent de polyarthrite rhumatoide objectivant des destructions articulaires retrouver une augmentation de la protéine C-réactive (26, : pincements des interlignes articulaires au niveau des poignets, 31-35), du facteur rhumatoïde (35,36) et des anticorps MCP et IPP avec multiples érosions. antinucléaires 50,55. L’étude anatomo-pathologique n’est pas un examen de pratique courante. Les auteurs ont décrit Parfois on peut assister à des arthralgies simples voire la présence de synovite minime sans prolifération synoviale arthrite déformante et érosive. marquée (37). Il existe un dépôt de fibrine, des corpuscules d’hématoxyline, un léger infiltrat inflammatoire et une KAHN et coll. (25) ont défini des critères diagnostiques du RJ : altération microvasculaire (26). - Déformations permanentes bilatérales, quel qu’en Diagnostic différentiel soit le type, des articulations radiocarpiennes, MCP ou Le principal diagnostic différentiel du RJ est la PR. Néanmoins, interphalangiennes dans la PR les déformations sont irréductibles avec présence - Antécédents d’arthrite inflammatoire prouvée de destructions articulaires (figure 4). Dans le RJ, les érosions - Absence d’inflammation résiduelle après au moins six mois sont peu nombreuses, petites et asymétriques, avec aspect en «crochet» ou d’une «faucille» (38). Ces lésions ne sont - Réductibilité partielle ou totale de la déformation pas spécifiques et peuvent être observées dans la goutte, - Absence de signes radiologiques
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