|LETTER TO EDITOR
|Ahead of print publication
Anti- Jo-1 myositis with subluxating arthropathy
Asna shaikh, Sandeep Yadav, Rohini Samant
Department of Rheumatology, P. D. Hinduja Hospital, Mumbai, Maharashtra, India
|Date of Submission||01-Dec-2021|
|Date of Acceptance||04-Jan-2022|
|Date of Web Publication||06-Jul-2022|
Department of Rheumatology, P. D. Hinduja Hospital, Mumbai, Maharashtra
Source of Support: None, Conflict of Interest: None
| Presentation|| |
A 53-year-old female presented with a 3-year history of proximal muscle weakness in lower limbs associated with difficulty getting up from squatting posture without truncal or respiratory muscle weakness. She had elevated phosphokinase levels (creatine phosphokinase), and her myositis profile was positive for the anti-Jo-1 antibody. She had roughened skin with cuts along the radial aspect of her digits, basilar crepitations confirmed as interstitial lung disease (ILD) on chest computed tomography and the absence of Raynaud's phenomenon. She was diagnosed with anti-synthetase syndrome with active myositis and ILD. We managed her with five cycles of plasma exchange, pulse methylprednisolone (500 mg) followed by deflazacort and mycophenolate mofetil (2 gm). She responded well to the treatment and underwent remission within a year. After 3 years of continued remission, she presented with a 4-month history of painless deformity of her right hand's second distal interphalangeal joint (DIP). A radiograph of her hand revealed lateral subluxation of the right 2nd DIP joint, as shown in [Figure 1]a. Magnetic resonance imaging showed partial resorption of the head of the middle phalanx of the right index finger, with the tear of the ulnar collateral ligament and lateral subluxation of DIP. There was also evidence of fluid collection in the middle phalanx extending deep up to the flexor tendon, suggestive of synovitis, as shown in [Figure 1]b.
|Figure 1: a) Radiograph of the right had showing subluxation of 2nd distal interphalangeal b) MRI of the right-hand showing subluxation of the 2nd Distal interphalangeal joint with associated flexor tenosynovitis|
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| Discussion|| |
The anti-Jo-1 antibody is the most frequently detected antibody in a patient with anti-synthetase syndrome. In the Indian population, the most common myositis-specific antibodies are anti-Jo-1 (10%) and are associated with mechanics' hands, arthritis, and ILD. Recent reports suggest that anti-synthetase syndrome may present as seronegative arthritis at the outset. Besides, periarticular calcification of the DIP with a subluxation has been reported in anti-jo-1-positive myositis. This image highlights that anti-Jo-1-positive inflammatory myositis may present with subluxation arthropathy, otherwise most common in lupus and not reported in myositis. Hence, it might be worthwhile to keep a keen eye on suspicion and check for anti-jo-1 antibodies not only in patients with myositis and ILD but also in DIP subluxation arthritis.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
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Conflicts of interest
There are no conflicts of interest.
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