Sarcoidois: is it only a mimicker of primary rheumatic disease? A single center experience

Abstract

Background: Sarcoidosis is known as a T helper 1 lymphocyte (Th1-Ly) mediated disease which can imitate or sometimes accompany many primary rheumatic diseases. The purpose of this study is to share the clinical, demographic and laboratory data of patients presenting with rheumatologic manifestations and diagnosed with sarcoidosis. Methods: A total of 42 patients (10 men) were included in the study. The patients were admitted to the rheumatology outpatient clinic for the first time with different rheumatic complaints between November 2011 and May 2013 and were diagnosed with sarcoidosis after relevant tests. Clinical, demographic, laboratory, radiological and histological data of these patients were collected during the 18-month follow-up period and then analyzed. Results: Mean patient age was 45.2 years (20-70 years) and mean duration of disease was 3.5 years (1 month-25 years). Evaluation of system and organ involvement revealed that 20 (47.6%) patients had erythema nodosum, 3 (7.1%) had uveitis, 1 (2.3%) had myositis, 1 (2.3%) had neurosarcoidosis, 32 (76.2%) had arthritis and 40 (95.2%) had arthralgia. Of the 32 patients with arthritis, 28 (87.5%) had involvement of the ankle, 3 (9.4%) had involvement of the knee and 1 (3.2%) had involvement of the wrist. No patient had cardiac involvement. Thoracic computed tomography scan showed stage 1, 2, 3 and 4 sarcoidosis in 12 (28.5%), 22 (52.4%), 4 (9.5%) and 4 (9.5%) patients, respectively. Histopathology of sarcoidosis was verified by endobronchial ultrasound, mediastinoscopy and skin and axillary biopsy of lymphadenopathies, which revealed noncaseating granulomas. Laboratory tests showed elevated serum angiotensin-converting enzyme in 15 (35.7%) patients, elevated serum calcium level in 6 (14.2%) patients and elevated serum 1,25-dihydroxyvitamin D concentrations in 2 (4.7%) patients. Serological tests showed antinuclear antibody positivity in 12 (28.5%) patients, rheumatoid factor positivity in 7 (16.6%) patients and anticyclic citrullinated antibody positivity in 2 (4.8%) patients. Conclusion: Sarcoidosis can imitate or accompany many primary rheumatic diseases. Sarcoidosis should be considered not simply as an imitator but as a primary rheumatic pathology mediated by Th1-Ly. New studies are warranted on this subject.

Co-occurrence of rheumatoid arthritis and sarcoidosis

“…The most frequent presentation of the disease is bilateral hilar lymphadenopathies, pulmonary infiltrations, and skin and eye lesions. Sarcoidosis may imitate various primary rheumatological diseases (connective tissue diseases, spondyloarthritis, vasculitis) and may be seen coincidently with them 7. Rheumatoid arthritis (RA) is a chronic inflammatory disease that may be cause erosive synovitis and extra-articular involvement.…”

Sarcoidosis presenting as orbital pseudotumor

“…Sarcoidosis is more likely to occur among females in the fi fth decade of life. It is a chronic granulomatous disease with various clinical presentations (6). The most common are pulmonary infi ltrations, enlarged hilar lymph nodes, skin and eye lesions.…”

Arthritis in sarcoidosis: A multicentric study from India

“…We had a total of 117 patients with sarcoid arthritis (88 with acute arthritis and 29 with chronic arthritis). Table summarizes the series of acute sarcoid arthritis, whereas Table summarizes the series of chronic sarcoid arthritis reported from all over the world. To the best of our knowledge, ours is the largest series of chronic sarcoid arthritis reported in adults.…”