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Anti- Jo-1 myositis with subluxating arthropathy

 Department of Rheumatology, P. D. Hinduja Hospital, Mumbai, Maharashtra, India

Date of Submission01-Dec-2021
Date of Acceptance04-Jan-2022
Date of Web Publication06-Jul-2022

Correspondence Address:
Asna shaikh,
Department of Rheumatology, P. D. Hinduja Hospital, Mumbai, Maharashtra
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/injr.injr_268_21

How to cite this URL:
shaikh A, Yadav S, Samant R. Anti- Jo-1 myositis with subluxating arthropathy. Indian J Rheumatol [Epub ahead of print] [cited 2022 Dec 5]. Available from:

  Presentation Top

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 Top

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.[1] Recent reports suggest that anti-synthetase syndrome may present as seronegative arthritis at the outset.[2] Besides, periarticular calcification of the DIP with a subluxation has been reported in anti-jo-1-positive myositis.[3] 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.[4] 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.

  References Top

Gupta L, Naveen R, Gaur P, Agarwal V, Aggarwal R. Myositis-specific and myositis-associated autoantibodies in a large Indian cohort of inflammatory myositis. Semin Arthritis Rheum 2021;51:113-20.  Back to cited text no. 1
Kumar RR, Jha S, Dhooria A, Naidu GS, Minz RW, Kumar S, et al. Anti-Jo-1 syndrome often misdiagnosed as rheumatoid arthritis (for many years): A single-center experience. J Clin Rheumatol 2021;27:150-5.  Back to cited text no. 2
Oddis CV, Medsger TA Jr., Cooperstein LA. A subluxing arthropathy associated with the anti-Jo-1 antibody in polymyositis/dermatomyositis. Arthritis Rheum 1990;33:1640-5.  Back to cited text no. 3
Santiago MB, Galvão V. Jaccoud arthropathy in systemic lupus erythematosus: Analysis of clinical characteristics and review of the literature. Medicine (Baltimore) 2008;87:37-44.  Back to cited text no. 4


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