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Multiple distal interphalangeal joint dislocation
ARTICLES
26 Ansell D, Feest T. Second annual report of the UK renal registry. Bristol: UK Renal Registry, Southmead Hospital, 1999. 27 Chandna SM, Schulz J, Lawrence C, Greenwood RN, Farrington K. Is there a rationale for rationing chronic dialysis? A hospital based cohort study of factors affecting survival and morbidity. BMJ 1999; 318: 217–23. 28 Leng GC, Lee AJ, Fowkes GR, et al. Incidence, natural history and cardiovascular events in symptomatic and asymptomatic peripheral vascular disease in the general population. Int J Epid 1996; 25: 1172–81. 29 Concato J, Horwitz RI, Feinstein AR, Elmore JG, Schiff SF.
Problems of comorbidity in mortality after prostatectomy. JAMA 1992; 67: 1077–82. 30 Mallick NP. The cost of renal services in Britain. Nephrol Dial Transplant 1997; 12 (suppl 1): 25–28. 31 Wonderling D, Langham S, Buxton M, Normand C, McDermott C. What can be concluded from the Oxcheck and British Family Heart Studies: commentary on cost-effectiveness analysis. BMJ 1996; 312: 1274–78. 32 Brazier JE, Harper R, Thomas K, Jones N, Usherwood T. Deriving a preference based single index measure from the SF-36. J Clin Epid 1998; 51: 1115–29.
Clinical picture
Multiple distal interphalangeal joint dislocation Yuki Nanke, Shigeru Kotake, Hideto Akama, Hajime Yamagata, Naoyuki Kamatani
A 64-year-old man consulted for dyspnoea and polyarthralgia in May, 2000. He had been suffering with polyarthralgia involving the wrists and distal interphalangeal (DIP) joints with Raynaud's phenomenon and dry eyes and mouth for 14 years. All DIP joints were dislocated without skin eruptions or hyperelasticity. His muscle power was normal. The hand radiographs showed dislocations of DIP joints without erosive changes. Chest radiograph and computed tomogram demonstrated interstitial pneumonia. Anti-SSA and Anti Jo-1 antibodies were present. Serum creatine kinase and aldolase levels were normal. The patient was diagnosed as having Sjögren's syndrome by ophthalmological examination. His 24year-old daughter also had hypermobile joints. Since the patient and the daughter had hypermobile joints we hypothesise that the aetiology of the dislocations in these cases is at least in part genetic. This is the second case we have observed. Joint symptoms are commonly reported in rheumatic disease. In patients with connective tissue disease, deforming arthritides are reported, some of which are associated with autoantibodies. On the other hand, there are several inheritable diseases causing arthropathy. Institute of Rheumatology, Tokyo Women's Medical University, Tokyo 162-0054, Japan (Y Nanke PhD, S Kotake PhD, H Akama PhD, N Kamatani PhD); and National Murayama Hospital, 2-37-1 Gakuen, Tokyo, Japan (H Yamagata PhD)
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26 Ansell D, Feest T. Second annual report of the UK renal registry. Bristol: UK Renal Registry, Southmead Hospital, 1999. 27 Chandna SM, Schulz J, Lawrence C, Greenwood RN, Farrington K. Is there a rationale for rationing chronic dialysis? A hospital based cohort study of factors affecting survival and morbidity. BMJ 1999; 318: 217–23. 28 Leng GC, Lee AJ, Fowkes GR, et al. Incidence, natural history and cardiovascular events in symptomatic and asymptomatic peripheral vascular disease in the general population. Int J Epid 1996; 25: 1172–81. 29 Concato J, Horwitz RI, Feinstein AR, Elmore JG, Schiff SF.
Problems of comorbidity in mortality after prostatectomy. JAMA 1992; 67: 1077–82. 30 Mallick NP. The cost of renal services in Britain. Nephrol Dial Transplant 1997; 12 (suppl 1): 25–28. 31 Wonderling D, Langham S, Buxton M, Normand C, McDermott C. What can be concluded from the Oxcheck and British Family Heart Studies: commentary on cost-effectiveness analysis. BMJ 1996; 312: 1274–78. 32 Brazier JE, Harper R, Thomas K, Jones N, Usherwood T. Deriving a preference based single index measure from the SF-36. J Clin Epid 1998; 51: 1115–29.
Clinical picture
Multiple distal interphalangeal joint dislocation Yuki Nanke, Shigeru Kotake, Hideto Akama, Hajime Yamagata, Naoyuki Kamatani
A 64-year-old man consulted for dyspnoea and polyarthralgia in May, 2000. He had been suffering with polyarthralgia involving the wrists and distal interphalangeal (DIP) joints with Raynaud's phenomenon and dry eyes and mouth for 14 years. All DIP joints were dislocated without skin eruptions or hyperelasticity. His muscle power was normal. The hand radiographs showed dislocations of DIP joints without erosive changes. Chest radiograph and computed tomogram demonstrated interstitial pneumonia. Anti-SSA and Anti Jo-1 antibodies were present. Serum creatine kinase and aldolase levels were normal. The patient was diagnosed as having Sjögren's syndrome by ophthalmological examination. His 24year-old daughter also had hypermobile joints. Since the patient and the daughter had hypermobile joints we hypothesise that the aetiology of the dislocations in these cases is at least in part genetic. This is the second case we have observed. Joint symptoms are commonly reported in rheumatic disease. In patients with connective tissue disease, deforming arthritides are reported, some of which are associated with autoantibodies. On the other hand, there are several inheritable diseases causing arthropathy. Institute of Rheumatology, Tokyo Women's Medical University, Tokyo 162-0054, Japan (Y Nanke PhD, S Kotake PhD, H Akama PhD, N Kamatani PhD); and National Murayama Hospital, 2-37-1 Gakuen, Tokyo, Japan (H Yamagata PhD)
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THE LANCET • Vol 356 • November 4, 2000