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Key Features

  • May occur early (within 6 months of onset of symptoms) or late

  • Often associated with erythema nodosum

  • Rarely deforming

Clinical Findings

  • Early arthritis

    • Usually begins in one or both ankles and can additively involve knees, wrists, and hands

    • Strongly associated with erythema nodosum and often produces more periarticular swelling than frank joint swelling

    • Axial skeleton spared

    • Commonly self-limited, resolving after several weeks or months and rarely resulting in chronic arthritis, joint destruction, or significant deformity

  • Late arthritis is less severe and less widespread

  • Dactylitis (sausage digit) may occur in association with overlying cutaneous sarcoidosis

  • Often associated with erythema nodosum

Diagnosis

  • Contingent on demonstration of other extra-articular manifestations of sarcoidosis and biopsy evidence of noncaseating granulomas

  • In chronic arthritis, radiographs show typical changes in the bones of the extremities with intact cortex and cystic changes

  • Despite the clinical appearance of an inflammatory arthritis, synovial fluid often is noninflammatory (ie, < 2000 leukocytes/mcL)

Treatment

  • Usually symptomatic and supportive

  • Corticosteroids or TNF inhibitors may be effective in patients with severe and progressive joint disease

  • Colchicine may be of value

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