Arthritis in Sarcoidosis

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 [2.0 × 10⁹/L])

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