Sarcoid arthritis: clinical characteristics, diagnostic aspects, and risk factors

Abstract

Objectives: (a) To describe the clinical characteristics of acute sarcoid arthritis and the diagnostic value of its presenting clinical features; (b) to evaluate whether disease onset is seasonal; and (c) to evaluate whether smoking behaviour or the presence of HLA class II alleles is a risk factor for the disease. Methods: 579 consecutive patients with recent onset arthritis who had been newly referred to a rheumatology outpatient clinic were included in a prospective cohort study. The presenting clinical features, the smoking behaviour, and the results of HLA-DQ and HLA-DR DNA typing of 55 patients with sarcoid arthritis, 524 patients with other arthritides of recent onset, and samples of the normal population were compared. Results: In all cases the disease showed a self limiting arthritis and overall good prognosis. The diagnostic ability of a combination of four clinical features-symmetrical ankle arthritis, symptoms of less than two months, age below 40 years, and erythema nodosum-was exceptionally high. When test positivity is defined as the presence of at least three of four criteria the set rendered a sensitivity of 93%, a specificity of 99%, a positive predictive value of 75%, and a negative predictive value of 99.7%. The disease clustered in the months March-July. The disease was negatively associated with smoking (odds ratio (OR) 0.09; 95% confidence interval (95% CI) 0.02 to 0.37) and positively associated with the presence of the DQ2 (DQB1*0201)-DR3 (DRB1*0301) haplotype (OR 12.33; 95% CI 5.97 to 25.48). Conclusion: The disease entity acute sarcoid arthritis has highly diagnostic clinical features. The seasonal clustering, the protective effect of smoking, and the association with specific HLA class II antigens support the hypothesis that it results from exposure of susceptible hosts to environmental agents through the lungs.

Romatolog gözüyle sarkoidoz

“…En s›k diz ve ayak bile¤i eklemleri tutulursa da; el bile¤i, diz ve metakarpofalangiyal eklemler de tutulabilir. [13,14] En s›k görülen eklem tutulufl örne¤i akut poliartrit ve/veya periartrittir. Akut poliartrit genellikle benign seyreder ve olgular›n ço¤unda haftalar içinde geriler; %10 olguda nüksler görülebilir, ancak genellikle eklem hasar› yapmaz.…”

“…Akut sarkoid artritin ço¤un-lukla ilkbahar aylar›nda ortaya ç›kmas› ilginç bir gözlem-dir. [13][14][15] Tan› an›nda serum ACE düzeyi normal olan olgularda artritin daha iyi seyretti¤i bildirilmifltir. [1] Kronik sarkoid artriti omuz, diz, el-ayak bile¤i ve parmak eklemlerini tutan ve kal›c› hasar yapmayan oligo veya monoartrit fleklindedir.…”

“…'n›n sarkoid artrit tan› kriterleri. [13] • Eritema nodosum olmas› durumunda sarkoid artrit tan›s› konulabilir; duyarl›l›k %99 ve özgüllük %93 bulunmufltur. [13] …”

Sarcoidosis and sacroiliitis, a case report

“…Sacroiliitis is an inflammatory joint disease and its association with sarcoidosis is very rare. Only few cases have been described in the literature, even less if sacroiliitis is the first manifestation of sarcoidosis [2,3].…”

A rare form of sarcoidosis: a case of bone sarcoidosis

“…Although the etiology of sarcoidosis remains unknown, infectious, occupational agents, and factors associated with the seasons of the year are most likely involved (1)(2)(3)(4). It is a multisystem disease that most frequently involves lungs, lymph nodes, skin, and eyes (5).…”