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Yeung T, Grebowicz A, Nevskaya T, Zahid S, Pope JE. Joint involvement in sarcoidosis: systematic review and meta-analysis of prevalence, clinical pattern and outcome. Rheumatology (Oxford) 2024; 63:1803-1814. [PMID: 38281070 DOI: 10.1093/rheumatology/keae048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Revised: 12/04/2023] [Accepted: 12/28/2023] [Indexed: 01/29/2024] Open
Abstract
OBJECTIVES To characterize joint involvement (JI) in sarcoidosis, a systematic search of MEDLINE, EMBASE and Cochrane Library was conducted from inception to July 2022 for publications reporting its prevalence, pattern, treatment and outcome. METHODS The pooled prevalence estimates (PPE) with 95% CI were calculated using binomial distribution and random effects. Meta-regression method was used to examine factors affecting heterogeneity between studies. RESULTS Forty-nine articles were identified comprising a total of 8574 sarcoidosis patients, where 12% presented with JI (95% CI 10, 14; I2 = 0%). The PPE for sarcoid arthritis (SA) was 19% (95% CI 14, 24; I2 = 95%), and 32% (95% CI 13, 51; I2 = 99%) for arthralgia. Heterogeneity was due to higher JI prevalence reported in Western Asia and the Middle East, in rheumatology clinics and via surveys. Sample size of SA varied from 12 to 117 cases. Ankles were most frequently affected (PPE 80%) followed by knees and wrists. Monoarthritis was uncommon (PPE 1%; 95% CI 0, 2; I2 = 55%). Acute SA prevailed (PPE 79%; 95% CI 72, 88; I2 = 69%) with an equal proportion of oligo and polyarthritis and was frequently accompanied by erythema nodosum (PPE 62%; 95% CI 52, 71; I2 = 16%). Chronic SA was predominantly polyarticular with a higher frequency of the upper extremity joints affected. Most common non-articular manifestations with SA included fever (52%), erythema nodosum (41%), hilar adenopathy (86%) and interstitial lung disease (23%) of which one-third required corticosteroids and/or immunosuppressants. CONCLUSION SA occurred early in the disease with a PPE of 19% and most frequent pattern of acute oligo- or polyarthritis predominantly affecting the lower extremity large joints.
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Affiliation(s)
- Terence Yeung
- Division of Rheumatology, Department of Medicine, Schulich School of Medicine, University of Western Ontario, London, ON, Canada
| | - Adrian Grebowicz
- Division of Rheumatology, Department of Medicine, Schulich School of Medicine, University of Western Ontario, London, ON, Canada
| | - Tatiana Nevskaya
- Division of Rheumatology, Department of Medicine, Schulich School of Medicine, University of Western Ontario, London, ON, Canada
| | - Sulman Zahid
- Division of Rheumatology, Department of Medicine, Schulich School of Medicine, University of Western Ontario, London, ON, Canada
| | - Janet E Pope
- Division of Rheumatology, Department of Medicine, Schulich School of Medicine, University of Western Ontario, London, ON, Canada
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2
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Jorge AM, Ard KL, Turbett SE. Case 19-2024: A 46-Year-Old Man with Arthritis and Rash. N Engl J Med 2024; 390:2200-2207. [PMID: 38899698 DOI: 10.1056/nejmcpc2402482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/21/2024]
Affiliation(s)
- April M Jorge
- From the Departments of Medicine (A.M.J., K.L.A., S.E.T.) and Pathology (S.E.T.), Massachusetts General Hospital, and the Departments of Medicine (A.M.J., K.L.A., S.E.T.) and Pathology (S.E.T.), Harvard Medical School - both in Boston
| | - Kevin L Ard
- From the Departments of Medicine (A.M.J., K.L.A., S.E.T.) and Pathology (S.E.T.), Massachusetts General Hospital, and the Departments of Medicine (A.M.J., K.L.A., S.E.T.) and Pathology (S.E.T.), Harvard Medical School - both in Boston
| | - Sarah E Turbett
- From the Departments of Medicine (A.M.J., K.L.A., S.E.T.) and Pathology (S.E.T.), Massachusetts General Hospital, and the Departments of Medicine (A.M.J., K.L.A., S.E.T.) and Pathology (S.E.T.), Harvard Medical School - both in Boston
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3
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Yamamoto K, Ishii T, Takasaki T, Doi E, Kashima J, Shiota S, Miyazaki E. An Unusual Case of Sarcoidosis with a Prolonged Fever and Progressive Arthropathy. Intern Med 2024; 63:601-605. [PMID: 37380457 PMCID: PMC10937121 DOI: 10.2169/internalmedicine.1890-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 05/23/2023] [Indexed: 06/30/2023] Open
Abstract
A 70-year-old man had developed a high fever and arthralgia in his right elbow 6 months prior. Loxoprofen improved the symptoms temporarily, but arthropathy developed in other joints. Long-term recurrent arthropathy and the fever caused activity reduction and progressive debilitation. We performed fluorine-18 fluorodeoxyglucose-positron emission tomography and detected a positive accumulation in multiple joints and lymph nodes. A lymph node biopsy revealed epithelioid cell granulomas, which, along with elevated angiotensin-converting enzyme levels, led to the diagnosis of sarcoid arthropathy. After prednisolone administration, the fever and arthralgia resolved, and his activities of daily living improved. Clinicians should be aware of this type of sarcoid arthropathy.
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Affiliation(s)
- Kyoko Yamamoto
- Department of General Medicine, Oita University Faculty of Medicine, Japan
- Center for Medical Education, Oita University Faculty of Medicine, Japan
| | - Toshihiro Ishii
- Department of General Medicine, Oita University Faculty of Medicine, Japan
- Center for Community Medicine, Oita University Faculty of Medicine, Japan
| | - Tomomi Takasaki
- Department of General Medicine, Oita University Faculty of Medicine, Japan
| | - Eri Doi
- Department of General Medicine, Oita University Faculty of Medicine, Japan
- Center for Community Medicine, Oita University Faculty of Medicine, Japan
| | - Jin Kashima
- Center for Community Medicine, Oita University Faculty of Medicine, Japan
| | - Seiji Shiota
- Department of General Medicine, Oita University Faculty of Medicine, Japan
- Center for Community Medicine, Oita University Faculty of Medicine, Japan
| | - Eishi Miyazaki
- Department of General Medicine, Oita University Faculty of Medicine, Japan
- Center for Community Medicine, Oita University Faculty of Medicine, Japan
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Larsen K, Guma J, Mehannek R, Guma M. Acute Inflammatory Arthropathy and Hypercalcemia Leading to a Diagnosis of Primary Hyperparathyroidism in a Patient With Known Sarcoidosis. Cureus 2023; 15:e41110. [PMID: 37519519 PMCID: PMC10382643 DOI: 10.7759/cureus.41110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/28/2023] [Indexed: 08/01/2023] Open
Abstract
Calcium pyrophosphate deposition disease (CPPD) is a crystal-induced arthropathy characterized by calcium pyrophosphate crystal deposition in joints and soft tissues. The diagnosis is suggested by the presence of chondrocalcinosis on x-ray but is most often diagnosed by synovial fluid analysis (SFA). CPPD is associated with aging and metabolic disorders such as hyperparathyroidism. In this case, we present an 87-year-old woman with known sarcoidosis who presented with acute arthropathy, hypercalcemia, and radiographic evidence of CPPD. Her hypercalcemia had been attributed to her sarcoidosis in the past without a full workup. Hypercalcemia in the setting of suspected CPPD led to a full workup for hypercalcemia and ultimately led to a diagnosis of primary hyperparathyroidism. This case highlights the importance of a complete evaluation for hypercalcemia in the setting of CPPD, even when another disease, such as sarcoidosis, could explain hypercalcemia. Ultimately, CPPD aided in diagnosing hyperparathyroidism in our patient with known sarcoidosis.
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Affiliation(s)
- Kalee Larsen
- Internal Medicine, New York Medical College at Saint Michael's Medical Center, Newark, USA
| | - Jenna Guma
- Internal Medicine, Cooper University Hospital, Camden, USA
| | - Rime Mehannek
- Internal Medecine, New York Medical College at Saint Michael's Medical Center, Newark, USA
| | - Michael Guma
- Internal Medicine/Rheumatology, New York Medical College at Saint Michael's Medical Center, Newark, USA
- Internal Medicine/Rheumatology, Hackensack University Medical Center, Hackensack, USA
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5
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Hasbani GE, Uthman I, Jawad AS. Musculoskeletal Manifestations of Sarcoidosis. CLINICAL MEDICINE INSIGHTS. ARTHRITIS AND MUSCULOSKELETAL DISORDERS 2022; 15:11795441211072475. [PMID: 35185345 PMCID: PMC8854226 DOI: 10.1177/11795441211072475] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Accepted: 12/09/2021] [Indexed: 01/12/2023]
Abstract
Since its initial description in the late 19th century, sarcoidosis has been extensively studied. Although the general mechanism of immune activation is known, many details especially in the context of disease associations are still missing. One of such associations is the musculoskeletal complications that are widely variable in terms of presentation and response to treatment. Sarcoidosis can involve the joints leading to acute and, less commonly chronic, arthritis. While acute arthritis is mostly self-resolving in nature, chronic arthritis may lead to deformity and destruction of the joint. Sarcoidosis can also involve the muscles, leading to different pathologies primarily categorized according to the clinical presentation, despite the efforts to find a new classification based on imaging, histological, and clinical findings. The bones can be directly and indirectly affected. Different types of bone lesions have been described, although around half of these patients remain asymptomatic. Osteoporosis, increased risk of fractures, hypercalcemia, and hypercalciuria are examples of the indirect effect of sarcoidosis on the bones, possibly contributed to elevated levels of calcitriol. Nevertheless, sarcoidosis can be associated with small-vessel, medium-vessel, and large vessel vasculitis, although it is frequently difficult to differentiate between the co-existence of a pure vasculitis and sarcoidosis and sarcoid vasculitis.
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Affiliation(s)
- Georges El Hasbani
- Department of Internal Medicine, St. Vincent's Medical Center, Bridgeport, CT, USA
| | - Imad Uthman
- Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Ali Sm Jawad
- Department of Rheumatology, The Royal London Hospital, London, UK
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Sève P, Pacheco Y, Durupt F, Jamilloux Y, Gerfaud-Valentin M, Isaac S, Boussel L, Calender A, Androdias G, Valeyre D, El Jammal T. Sarcoidosis: A Clinical Overview from Symptoms to Diagnosis. Cells 2021; 10:cells10040766. [PMID: 33807303 PMCID: PMC8066110 DOI: 10.3390/cells10040766] [Citation(s) in RCA: 152] [Impact Index Per Article: 50.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 03/26/2021] [Accepted: 03/27/2021] [Indexed: 12/11/2022] Open
Abstract
Sarcoidosis is a multi-system disease of unknown etiology characterized by the formation of granulomas in various organs. It affects people of all ethnic backgrounds and occurs at any time of life but is more frequent in African Americans and Scandinavians and in adults between 30 and 50 years of age. Sarcoidosis can affect any organ with a frequency varying according to ethnicity, sex and age. Intrathoracic involvement occurs in 90% of patients with symmetrical bilateral hilar adenopathy and/or diffuse lung micronodules, mainly along the lymphatic structures which are the most affected system. Among extrapulmonary manifestations, skin lesions, uveitis, liver or splenic involvement, peripheral and abdominal lymphadenopathy and peripheral arthritis are the most frequent with a prevalence of 25-50%. Finally, cardiac and neurological manifestations which can be the initial manifestation of sarcoidosis, as can be bilateral parotitis, nasosinusal or laryngeal signs, hypercalcemia and renal dysfunction, affect less than 10% of patients. The diagnosis is not standardized but is based on three major criteria: a compatible clinical and/or radiological presentation, the histological evidence of non-necrotizing granulomatous inflammation in one or more tissues and the exclusion of alternative causes of granulomatous disease. Certain clinical features are considered to be highly specific of the disease (e.g., Löfgren's syndrome, lupus pernio, Heerfordt's syndrome) and do not require histological confirmation. New diagnostic guidelines were recently published. Specific clinical criteria have been developed for the diagnosis of cardiac, neurological and ocular sarcoidosis. This article focuses on the clinical presentation and the common differentials that need to be considered when appropriate.
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Affiliation(s)
- Pascal Sève
- Department of Internal Medicine, Lyon University Hospital, 69007 Lyon, France; (Y.J.); (M.G.-V.); (T.E.J.)
- Université Claude Bernard Lyon 1, Research on Healthcare Performance (RESHAPE), INSERM U1290, 69007 Lyon, France
- Correspondence:
| | - Yves Pacheco
- Faculty of Medicine, University Claude Bernard Lyon 1, F-69007 Lyon, France;
| | - François Durupt
- Department of Dermatology, Lyon University Hospital, 69004 Lyon, France;
| | - Yvan Jamilloux
- Department of Internal Medicine, Lyon University Hospital, 69007 Lyon, France; (Y.J.); (M.G.-V.); (T.E.J.)
| | - Mathieu Gerfaud-Valentin
- Department of Internal Medicine, Lyon University Hospital, 69007 Lyon, France; (Y.J.); (M.G.-V.); (T.E.J.)
| | - Sylvie Isaac
- Department of Pathology, Lyon University Hospital, 69310 Pierre Bénite, France;
| | - Loïc Boussel
- Department of Radiology, Lyon University Hospital, 69004 Lyon, France
| | - Alain Calender
- Department of Genetics, Lyon University Hospital, 69500 Bron, France;
| | - Géraldine Androdias
- Department of Neurology, Service Sclérose en Plaques, Pathologies de la Myéline et Neuro-Inflammation, Hôpital Neurologique Pierre Wertheimer, Lyon University Hospital, F-69677 Bron, France;
| | - Dominique Valeyre
- Department of Pneumology, Assistance Publique-Hôpitaux de Paris, Hôpital Avicenne et Université Paris 13, Sorbonne Paris Cité, 93008 Bobigny, France;
| | - Thomas El Jammal
- Department of Internal Medicine, Lyon University Hospital, 69007 Lyon, France; (Y.J.); (M.G.-V.); (T.E.J.)
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Cacciatore C, Belnou P, Thietart S, Desthieux C, Versini M, Abisror N, Ottaviani S, Cormier G, Deroux A, Dellal A, Belhomme N, Kermanac'H NS, Khafagy P, Michaud M, Lanot S, Carrat F, Fain O, Mékinian A. Acute and Chronic Sarcoid Arthropathies: Characteristics and Treatments From a Retrospective Nationwide French Study. Front Med (Lausanne) 2020; 7:565420. [PMID: 33363181 PMCID: PMC7758528 DOI: 10.3389/fmed.2020.565420] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Accepted: 10/16/2020] [Indexed: 12/26/2022] Open
Abstract
Introduction: We aimed to analyze patients with acute and chronic joint involvements in sarcoidosis. Methods: This is a retrospective multicenter analysis of patients with proven sarcoidosis, as defined by clinical, radiological, and histological criteria, with at least one clinical and/or ultrasonographic synovitis. Results: Thirty-nine patients with sarcoid arthropathy were included, and among them 19 had acute sarcoidosis (Lofgren's syndrome). Joint involvement and DAS44-CRP were not significantly different in acute and chronic sarcoid arthropathies. Acute forms were more frequent than chronic sarcoid arthropathy in Caucasians, without any difference of sex or age between these 2 forms. Joint involvement was frequently more symmetrical in acute than chronic forms (100 vs. 70%; p < 0.05), with a more frequent involvement in wrists and ankles in acute forms, whereas the tender and swollen joint counts and the DAS44-CRP were similar between the 2 groups. Skin lesions were significantly more frequent in patients with acute forms [17 (89%) vs. 5 (25%); p < 0.05] and were erythema nodosum in all patients with Löfgren's syndrome and sarcoid skin lesions in those with chronic sarcoidosis. Among 20 patients with chronic sarcoidosis, treatment was used in 17 (85%) cases, and consisted in NSAIDs alone (n = 5; 25%), steroids alone (n = 5; 25%), hydroxychloroquine (n = 2; 20%), methotrexate (n = 3; 15%), and TNF inhibitors (n = 2; 10%). A complete/partial joint response was noted in 14 (70%) cases with a DAS44-CRP reduction of 2.07 [1.85–2.44] (from 3.13 [2.76–3.42] to 1.06 [0.9–1.17]; p < 0.05). Conclusion: Sarcoid arthropathies have different clinical phenotypes in acute and chronic forms and various treatment regimens such as hydroxychloroquine and methotrexate could be used in chronic forms.
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Affiliation(s)
- Carlotta Cacciatore
- Sorbonne Université, Service de médecine interne, Hôpital Saint-Antoine, DHU I2B: Inflammation, Immunopathologie, Biothérapie, APHP, Paris, France
| | - Pierre Belnou
- Sorbonne Université, Service de santé publique, Hôpital Saint-Antoine, APHP, Paris, France
| | - Sara Thietart
- Sorbonne Université, Service de médecine interne, Hôpital Saint-Antoine, DHU I2B: Inflammation, Immunopathologie, Biothérapie, APHP, Paris, France
| | - Carole Desthieux
- Sorbonne Université, Service de médecine interne, Hôpital Saint-Antoine, DHU I2B: Inflammation, Immunopathologie, Biothérapie, APHP, Paris, France
| | - Mathilde Versini
- Service de Médecine interne, Centre Hospitalier Universitaire de Nice, Nice, France
| | - Noemie Abisror
- Sorbonne Université, Service de médecine interne, Hôpital Saint-Antoine, DHU I2B: Inflammation, Immunopathologie, Biothérapie, APHP, Paris, France
| | | | | | - Alban Deroux
- Service de médecine interne, CHU Grenoble, La Tronche, France
| | - Azeddine Dellal
- Service de rhumatologie, Hôpital Montfermeil, Montfermeil, France
| | - Nicolas Belhomme
- Service de médecine interne et immunologie clinique, CHU Rennes, Rennes, France
| | - Nathalie Saidenberg Kermanac'H
- Service de rhumatologie, Groupe hospitalier Avicenne-Jean Verdier-René Muret, APHP, Bobigny, France.,Sorbonne Paris Cité, Université Paris 13, INSERM U1125, Bobigny, France
| | | | - Martin Michaud
- Service de médecine interne, Hôpital Joseph Ducuing, Toulouse, France
| | - Sylvain Lanot
- Service de rhumatologie, C.H intercommunal Alençon-Mamers, Alençon, France
| | - Fabrice Carrat
- Sorbonne Université, Service de santé publique, Hôpital Saint-Antoine, APHP, Paris, France.,Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Paris, France
| | - Olivier Fain
- Sorbonne Université, Service de médecine interne, Hôpital Saint-Antoine, DHU I2B: Inflammation, Immunopathologie, Biothérapie, APHP, Paris, France
| | - Arsène Mékinian
- Sorbonne Université, Service de médecine interne, Hôpital Saint-Antoine, DHU I2B: Inflammation, Immunopathologie, Biothérapie, APHP, Paris, France
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Cutaneous Manifestation of Sarcoidosis in Lower-Back Tattoo With Increased Uptake of 18F-FDG. Clin Nucl Med 2018. [DOI: 10.1097/rlu.0000000000002061] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Undiagnosed renal sarcoidosis in a patient with chronic interstitial nephritis. Clin Rheumatol 2017; 36:2619-2622. [PMID: 28875342 DOI: 10.1007/s10067-017-3801-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2017] [Revised: 08/13/2017] [Accepted: 08/21/2017] [Indexed: 10/18/2022]
Abstract
A 53-year-old female was admitted to hospital, with acute elevation of SCr and hypercalcemia, on a 5-year history of chronic interstitial nephritis and stage III chronic kidney disease (CKD). Extensive workup failed to yield a definitive diagnosis concerning the cause of the disorder. Intense uptake of 18F-FDG in the spleen and liver was detected by PET/CT imaging with negative angiotensin-converting enzyme (ACE) in serum. The spleen and the hypermetabolism nodules of the liver were resected for histopathologic examination and turned out to be noncaseating granulomas, likely sarcoidosis. Combined with clinical features, the final diagnosis for this patient was sarcoidosis, involving the kidneys, spleen, liver, and lungs.
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