Acute Sarcoid Arthritis: Occurrence, Seasonal Onset, Clinical Features and Outcome

Glennås, A; Kvien, Tore K; Melby, K; Refvem, O; Andrup, O; Karstensen, B; Thöen, J.

doi:10.1093/rheumatology/34.1.45

Cited by 110 publications

(63 citation statements)

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“…A cluster of sarcoid arthritis in the spring, of which 10 out of 17 cases also had EN and lung involvement, was reported from Norway [1]. Unlike the present study there was no female preponderance but most had stage I chest radiography.…”

Section: Discussioncontrasting

confidence: 67%

Seasonal clustering of sarcoidosis presenting with erythema nodosum

Wilsher

1998

Eur Respir J

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Seasonal clustering of sarcoidosis presenting with erythema nodosum (EN) has previously been reported only in the northern hemisphere. Of 59 patients presenting to a single centre in New Zealand with a new diagnosis of sarcoidosis, 21 had EN and three more had acute arthralgia without EN. These patients were compared with the rest of the cohort. The patients with EN or arthralgia alone presented exclusively between April and December, with peak clustering in the spring months of August, September and October (p<0.001, Fisher's exact test). This cohort was more likely to have a stage I chest radiograph and to be female (p<0.05), but there were no other differences between the groups. This is the first report of seasonal clustering in the southern hemisphere suggesting a common environmental trigger in the aetiology of sarcoidosis.

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Section: Discussioncontrasting

confidence: 67%

Seasonal clustering of sarcoidosis presenting with erythema nodosum

Wilsher

1998

Eur Respir J

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“…Results demonstrated that despite early treatment and an overall initial improvement, the majority of patients were still symptomatic at 12 months. This finding indicates a significant level of disease persistence in a young population of patients and is consistent with other published studies (2,3,7). The purpose of the current study was to assess the efficacy of early intervention with intraarticular corticosteroids followed by therapy with SSZ in patients with persistent disease compared with initial NSAID therapy alone followed by later intervention with intraarticular corticosteroid and SSZ in cases of disease persistence.…”

Section: Introductionsupporting

confidence: 88%

A randomized controlled trial of early intervention with intraarticular corticosteroids followed by sulfasalazine versus conservative treatment in early oligoarthritis

Marzo‐Ortega¹,

Green²,

Keenan³

et al. 2007

Arthritis & Rheumatism

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Objective. To determine the outcome after 52 weeks of early intervention with intraarticular corticosteroid injections followed by sulfasalazine versus conservative therapy in patients with recent-onset oligoarthritis in a randomized controlled trial. Methods. Patients with <4 joints with clinical synovitis (disease duration <12 months) were randomized to early intervention (EI) with intraarticular methylprednisolone into all synovitic joints or to conservative treatment (CT) with nonsteroidal antiinflammatory drugs alone. Sulfasalazine was administered in both groups for persistent disease or disease that evolved into a polyarthritis. Primary outcome was complete response (CR) defined as the absence of synovitis at 52 weeks. Secondary outcomes included CR at weeks 4 and 12, function (Health Assessment Questionnaire), pain (0 -100-mm visual analog scale), and work status. Results. Fifty-nine patients (34 men, 25 women; mean age 32.9 years; median early morning stiffness 30 minutes) were randomized. At baseline, two-thirds reported that they were work impaired. At 52 weeks, 81% of patients in the EI group achieved CR compared with 57% in the CT group ( 2 ‫؍‬ 3.833, 1 df, P ‫؍‬ 0.05). In addition, 45% of patients in the EI group received sulfasalazine as opposed to 14% in the CT group ( 2 ‫؍‬ 5.156, 1 df, P ‫؍‬ 0.019). There were no differences in physical disability or work impairment between the treatment groups. Conclusion. Oligoarthritis has a significant impact on function and work ability. Patients treated with EI using intraarticular corticosteroids followed by sulfasalazine therapy if resistant demonstrated reduced synovitis 12 months after treatment compared with those initially treated with more conservative therapy.

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“…The similar clustering for the two patient subgroups is also in line with the suggestion that EN-positive and EN-negative patients have different manifestations of the same disease, with the same etiology. Several previous studies on acute sarcoidosis with EN, as well as on acute sarcoid arthritis, reported a seasonal clustering to the spring months (22)(23)(24)(25).…”

Section: Discussionmentioning

confidence: 89%

Sex-Specific Manifestations of Löfgren's Syndrome

Grünewald

Eklúnd

2007

Am J Respir Crit Care Med

146

102

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Motivation: It has been debated whether patients need to have erythema nodosum to be classified as having Löfgren's syndrome. In this study, we have therefore in detail evaluated and compared a large number of patients with an acute onset of sarcoidosis and bilateral hilar lymphadenopathy (BHL), with or without erythema nodosum (EN). This study is important because it may lead to a more accurate definition of Löfgren's syndrome, and an exact phenotype of patients is crucial in modern medical research. Background: Löfgren's syndrome is commonly regarded as a distinct clinical entity. Methods: We have in detail evaluated a large group of patients (n ϭ 150) with an acute onset of sarcoidosis with BHL, in most cases with fever, EN, and/or bilateral ankle arthritis or periarticular inflammation. Within this group, 87 patients had EN (EN positive), whereas 63 were without EN (EN negative), though with distinct symmetric ankle inflammation. Results: EN-positive and EN-negative patients were identical in every aspect except that there were significantly more women in the ENpositive group: 58 women (67%) in the EN-positive group compared with only 17 (27%) women in the EN-negative group (p Ͻ 0.0001). In all other aspects, such as age, smoking habits, seasonal clustering of disease onset, rate of positive biopsies, chest radiography, pulmonary function, bronchoalveolar lavage cell distributions including the typically increased CD4/CD8 ratio, and clinical development of the disease, the EN-positive and EN-negative groups were close to identical. The two groups were also identically strongly associated with HLA-DRB1*0301/DQB1*0201, with 60 (69.0%) and 44 (69.8%) patients having this particular HLA type in the EN-positive and EN-negative groups, respectively. Such patients recovered to the same degree-that is, at almost 100%. Conclusions: We conclude that manifestations of Löfgren's syndrome differ between men and women, with EN found predominantly in women, whereas a marked periarticular inflammation of the ankles or ankle arthritis without EN is seen preferentially in men.

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Acute Sarcoid Arthritis: Occurrence, Seasonal Onset, Clinical Features and Outcome

Cited by 110 publications

References 0 publications

Seasonal clustering of sarcoidosis presenting with erythema nodosum

Seasonal clustering of sarcoidosis presenting with erythema nodosum

A randomized controlled trial of early intervention with intraarticular corticosteroids followed by sulfasalazine versus conservative treatment in early oligoarthritis

Sex-Specific Manifestations of Löfgren's Syndrome

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