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AB0338 Heads-up! sarcoidosis and rheumatoid arthritis co-exist
  1. L Zickuhr,
  2. R Hajj-Ali
  1. Rheumatology, Cleveland Clinic Foundation, Cleveland, United States

Abstract

Background Sarcoidosis and rheumatoid arthritis (RA) uncommonly co-occur. How dual diagnosis affects these patients' clinical phenotype is unknown.

Objectives To characterize the clinical and laboratory phenotype and to increase awareness of the coexistence of sarcoidosis and RA.

Methods We searched PubMed from 1980–2016 for relevant articles using key words “sarcoidosis” and “rheumatoid arthritis,” excluding cases with tumor necrosis factor inhibitors. We found 12 cases, omitted 5 lacking clinical detail, and added 2 from our experience at the Cleveland Clinic. Clinical features, laboratory and imaging findings were reviewed and summarized.

Results Females comprised 7/9 cases (77%). Our cases are the first to describe men with dual diagnosis. Of the 8 cases reporting ethnicity, 4 (50%) were white. The mean age at time of diagnosis was 35.3 years for RA and 51.0 years for sarcoidosis. In 5/9 cases (55%), RA preceded sarcoidosis. RA affected the hands in 8/9 patients (88.9%). Of the 8 cases reporting symptoms of sarcoidosis, 5 (62.5%) had dyspnea. All cases (100%) had elevated rheumatoid factor (RF) and, when checked, anti-citrullinated peptide (anti-CCP) antibodies. Angiotensin converting enzyme (ACE) was elevated in 6/9 patients (66.6%). Of the 5 patients with joint imaging, 4 (80%) had inflammatory changes. All sarcoidosis (100%) was biopsy-proven. One case (11.1%) demonstrated concomitant pulmonary RA and sarcoidosis.

Conclusions Sarcoidosis and RA coexist in seropositive patients, most commonly in women in their fourth through sixth decades of life. RA preceded sarcoidosis about half the time. Hand arthritis and dyspnea were the most common symptoms for RA and sarcoidosis, respectively. Awareness of this dual diagnosis may help identify RA and sarcoidosis earlier and prevent treatment delay.

References

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  2. Menard O, et al. Association of histologically proven rheumatoid arthritis with pulmonary sarcoidosis. Eur Respir J, 1995; 8;472–3.

  3. Kobak S, et al. Co-occurrence of rheumatoid arthritis and sarcoidosis. BMJ Case Rep, 2015;1–3.

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References

Disclosure of Interest None declared

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