Arthritis in sarcoidosis: A multicentric study from India

Agarwal, Vikas; Agrawal, Vinita; Aggarwal, Amita; Aggarwal, Parshant; Chowdhury, Abhra Chandra; Ghosh, Parasar; Jain, Avinash; Lawrence, Able; Misra, Durga Prasanna; Mohapatra, Madhusmita Mohanty; Nath, Alok; Negi, Vir Singh; Pandya, Sapan; Reddy, V.U.; Prasad, Shiva; Sharma, Aman; Shobha, Vineeta; Singh, Yogesh Preet; Tripathy, Saumya Ranjan; Wakhlu, Anupam

doi:10.1111/1756-185x.13349

Cited by 13 publications

(4 citation statements)

References 23 publications

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“…Resolution of the inflammatory arthritis usually occurs within 6 weeks in most patients and within 2 years in almost all patients 20, 28, 29. Enthesitis (especially Achilles tendinitis) can also be found in patients with sarcoid arthropathy; the prevalence is about 5% to 8% 28, 30…”

Section: Clinical Manifestationsmentioning

confidence: 99%

Clinical Manifestations, Diagnosis, and Treatment of Sarcoidosis

Ungprasert

Ryu

Matteson

2019

Mayo Clinic Proceedings: Innovations, Quality & Outcomes

183

192

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The focus of this review is current knowledge about the epidemiology, clinical manifestations, diagnosis, and treatment of both pulmonary sarcoidosis and extrapulmonary sarcoidosis. Although intrathoracic involvement is the hallmark of the disease, present in over 90% of patients, sarcoidosis can affect virtually any organ. Clinical presentations of sarcoidosis are diverse, ranging from asymptomatic, incidental findings to organ failure. Diagnosis requires the presence of noncaseating granuloma and compatible presentations after exclusion of other identifiable causes. Spontaneous remission is frequent, so treatment is not always indicated unless the disease is symptomatic or causes progressive organ damage/dysfunction. Glucocorticoids are the cornerstone of treatment of sarcoidosis even though evidence from randomized controlled studies is lacking. Glucocorticoid-sparing agents and biologic agents are often used as second- and third-line therapy for patients who do not respond to glucocorticoids or experience serious adverse effects.

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Section: Clinical Manifestationsmentioning

confidence: 99%

Clinical Manifestations, Diagnosis, and Treatment of Sarcoidosis

Ungprasert

Ryu

Matteson

2019

Mayo Clinic Proceedings: Innovations, Quality & Outcomes

183

192

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“…1 ) shows the inclusion process. We obtained 41 articles in full text and included 11 articles [ 4 , 17 – 26 ], which are listed in Table 1 . One article [ 53 ] was in Spanish and was therefore excluded.…”

Section: Resultsmentioning

confidence: 99%

“…In most cases, the respiratory system is involved [ 3 ], other affected organ systems are skin, eyes, and systemic symptoms, such as fever, night sweats, fatigue, and malaise. Within the musculoskeletal system, ankles, knees and wrists are the most commonly involved joints, with oligo-articular involvement more prominent in acute arthritis [ 4 ].…”

Section: Introductionmentioning

confidence: 99%

Sarcoidosis with musculoskeletal manifestations: systematic review of non-pharmacological and pharmacological treatments

2022

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We aimed to summarise effects and use of non-pharmacological and pharmacological treatments for sarcoidosis with musculoskeletal manifestations. We systematically searched the Cochrane Library, Ovid MEDLINE, Embase, CINAHL, AMED, Scopus, clinical.trials.gov, PROSPERO and PEDro for systematic reviews from 2014 to 2022 and for primary studies from date of inception to March 29, 2022, and studies with patients diagnosed with sarcoidosis with musculoskeletal manifestations. Inclusion criteria required that studies reported effects of non-pharmacological and/or pharmacological treatments or number of patients receiving these treatments. Results were reported narratively and in forest plots. Eleven studies were included. No systematic reviews fulfilled our inclusion criteria. None of the included studies had a control group. We found that between 23 and 100% received corticosteroids, 0–100% received NSAIDs, 5–100% received hydroxychloroquine, 12–100% received methotrexate, 0–100% received TNF inhibitors, and 3–4% received azathioprine. Only ten patients in one study had used non-pharmacological treatments, including occupational therapy, chiropractic and acupuncture. There are no controlled studies on treatment effects for patients with sarcoidosis with musculoskeletal manifestations. We found 11 studies reporting use of pharmacological treatments and only one study reporting use of non-pharmacological treatments. Our study identified major research gaps for pharmacological and non-pharmacological treatment in musculoskeletal sarcoidosis and warrant randomised clinical trials for both.

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“…Hydroxychloroquine and chloroquine (CQ) may be useful in non-life-threatening organ involvement (symptomatic persistent pulmonary sarcoidosis 69 such as mild hypercalcemia, 56 moderate cutaneous sarcoidosis, 70 and mild cranial neuropathies 71 ) Sarcoidosis-related joint involvement may also improve under treatment. 72 The advantage of antimalarial drug use is based on its excellent safety profile (especially for HCQ). Nevertheless, some rare but severe complications may occur such as anti-malarial myopathy or cardiomyopathy and antimalarial maculopathy.…”

Section: Antimalarial Drugsmentioning

confidence: 99%

<p>Refractory Sarcoidosis: A Review</p>

Jammal

Jamilloux

Gerfaud‐Valentin

et al. 2020

TCRM

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Sarcoidosis is a multi-system disease of unknown etiology characterized by granuloma formation in various organs (especially lung and mediastinohilar lymph nodes). In more than half of patients, the disease resolves spontaneously. When indicated, it usually responds to corticosteroids, the first-line treatment, but some patients may not respond or tolerate them. An absence of treatment response is rare and urges for verifying the absence of a diagnosis error, the good adherence of the treatment, the presence of active lesions susceptible to respond since fibrotic lesions are irreversible. That is when second-line treatments, immunosuppressants (methotrexate, leflunomide, azathioprine, mycophenolate mofetil, hydroxychloroquine), should be considered. Methotrexate is the only first-line immunosuppressant validated by a randomized controlled trial. Refractory sarcoidosis is not yet a well-defined condition, but it remains a real challenge for the physicians. Herein, we considered refractory sarcoidosis as a disease in which second-line treatments are not sufficient to achieve satisfying disease control or satisfying corticosteroids tapering. Tumor necrosis alpha inhibitors, third-line treatments, have been validated through randomized controlled trials. There are currently no guidelines or recommendations regarding refractory sarcoidosis. Moreover, criteria defining non-response to treatment need to be clearly specified. The delay to achieve response to organ involvement and drugs also should be defined. In the past ten years, the efficacy of several immunosuppressants beforehand used in other autoimmune or inflammatory diseases was reported in refractory cases series. Among them, anti-CD20 antibodies (rituximab), repository corticotrophin injection, and anti-JAK therapy anti-interleukin-6 receptor monoclonal antibody (tocilizumab) were the main reported. Unfortunately, no clinical trial is available to validate their use in the case of sarcoidosis. Currently, other immunosuppressants such as JAK inhibitors are on trial to assess their efficacy in sarcoidosis. In this review, we propose to summarize the state of the art regarding the use of immunosuppressants and their management in the case of refractory or multidrugresistant sarcoidosis.

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Arthritis in sarcoidosis: A multicentric study from India

Cited by 13 publications

References 23 publications

Clinical Manifestations, Diagnosis, and Treatment of Sarcoidosis

Clinical Manifestations, Diagnosis, and Treatment of Sarcoidosis

Sarcoidosis with musculoskeletal manifestations: systematic review of non-pharmacological and pharmacological treatments

<p>Refractory Sarcoidosis: A Review</p>

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