Background Sarcoidosis is a systemic granulomatous disease, being the joint involvement a poorly studied manifestation.
Objectives To describe the clinical and demographic characteristics of patients with sarcoidosis, paying particular attention to the joint involvement and its possible relationship with other extra-articular manifestations, as well as the treatment recieved.
Methods A retrospective, observational study that included 104 patients who were admitted to the Hospital of Leόn between January 2011 and December 2015 with main or secondary diagnosis of sarcoidosis; according to clinical onset, imaging tests and/or anatomopathological study. The variables studied were: age at the time of diagnosis, sex, type of joint involvement, forms of extra-articular involvement, serologic parameters and drugs received. Statistical analysis was performed using SPSSv22.0, p<0.005.
Results 57.7% of the patients included in the study were women with a mean age of 53.42±18.4 years. At the systemic level, 35% of them presented fever, 66.3% lymphadenopathy and 4.8% splenomegaly. 97.1% of the patients presented pulmonary involvement, with stage II being the most common (46.2%). Only 8 patients had cardiac abnormalities. Ocular involvement was observed in 10.6%, predominating uveitis. The most common renal manifestation was hypercalciuria in 6.7%. The presence of neurological involvement was exceptional, detecting 3 cases of neurosarcoidosis. In the cutaneous involvement (2.9%), erythema nodosum predominated (17.3%). The CRP levels were normal in 44.3% (<5mg/dl) and high levels of CRP were found in 25.3% of the sample (>30mg/dl). 62.6% presented pathological figures of ACE. The joint involvement was present in 38.5% of the patients (14.4% in the form of arthralgia, 2.9% as periarthritis, 13.5% as acute arthritis, 4.8% as chronic arthritis and 2.9% as sacroiliitis). The 19,23% debuted as Löefgren syndrome, being seen an association between the presence of acute arthritis and erythema nodosum (p0,000). The mean age observed in patients with acute arthritis was lower than the one of the other patients with other joint manifestations (p0.044) and a statistically significant relationship was observed between the absence of joint and ocular involvement (p0,011). Regarding the treatment of joint manifestations, 30.77% of the cases were resolved with NSAIDs, 46.15% with corticosteroids in a monotherapy and 15.38% required an immunosuppressant. In our study, most patients treated with corticosteroids did not show articular nor ocular involvement (p0,018), although when analysing the ocular involvement separately, many received corticoid treatment (42.86%). Only one patient required Adalimumab for refractory uveitis and another presented anti-TNFα-induced sarcoidosis (Infliximab).
Conclusions The pulmonary involvement is the predominant one in patients with sarcoidosis. The acute arthritis occurs in younger patients and is associated with the onset of erythema nodosum. The joint involvement is usually not severe and, although it has not been demonstrated, it seems that the use of corticosteroids predominates in the extra-articular manifestations. Only 1 in 4 patients showed an increase of acute phase reactants.
Disclosure of Interest None declared