A single-center rheumatology experience of sarcoidosis: observations from 70 patients
Main Article Content
Keywords
sarcoidosis, rheumatology, arthritis, erythema nodosum
Abstract
Background: The aim of this study is to determine the demographic, clinical and laboratory characteristics of the patients who followed up with the diagnosis of sarcoidosis, to investigate the distribution frequency of rheumatological findings and to examine the disease management from the perspective of rheumatology.
Methods: Patients who were followed up with the diagnosis of sarcoidosis in the rheumatology clinic of Ankara City Hospital between November 2019 and November 2022 were evaluated. Demographic, clinical, radiological, serological, laboratory, and histopathological findings, and rheumatological, systemic, and locomotor system examination findings of the patients were obtained from the medical data registered in the hospital.
Results: A total of seventy sarcoidosis patients (48.98 ± 11.78 years, %75 female) were included in the study. Joint involvement was observed in 64.3% of cases, skin involvement in 48.6% of cases, and ocular involvement in 25.7% of cases. The ankle was the most frequently involved joint, followed by the knee and small joints in the foot. Corticosteroids were the most used therapeutic agent, and pulmonary and joint findings were the most common reasons for starting treatment.
Conclusions: Sarcoidosis is a disease that mimics many diseases, misdiagnosis and treatment should be avoided with a good and fast differential diagnosis. Clinicians, especially rheumatologists, should remember sarcoidosis more frequently and keep it in mind in the differential diagnosis.
References
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13. Valeyre D, Jeny F, Rotenberg C, Bouvry D, Uzunhan Y, Sève P, et al. How to Tackle the Diagnosis and Treatment in the Diverse Scenarios of Extrapulmonary Sarcoidosis. Adv Ther. 2021;38(9):4605-27.doi: 10.1007/s12325-021-01832-5.
14. Sweiss NJ, Patterson K, Sawaqed R, Jabbar U, Korsten P, Hogarth K, et al. Rheumatologic manifestations of sarcoidosis. Semin Respir Crit Care Med. 2010;31(4):463-73.doi: 10.1055/s-0030-1262214.
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16. Rana GD, d'Alessandro M, Rizzi L, Bergantini L, Cameli P, Vozza A, et al. Clinical phenotyping in sarcoidosis management. Sarcoidosis Vasc Diffuse Lung Dis. 2021;38(2):e2021007.doi: 10.36141/svdld.v38i2.10423.
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21. Pettersson T. Sarcoid and erythema nodosum arthropathies. Baillieres Best Pract Res Clin Rheumatol. 2000;14(3):461-76.doi: 10.1053/berh.2000.0088.
22. Visser H, Vos K, Zanelli E, Verduyn W, Schreuder GM, Speyer I, et al. Sarcoid arthritis: clinical characteristics, diagnostic aspects, and risk factors. Ann Rheum Dis. 2002;61(6):499-504.doi: 10.1136/ard.61.6.499.
23. Kaufman LD. Lofgren's syndrome (acute sarcoidosis) sine erythema nodosum mimicking acute rheumatoid arthritis. N Y State J Med. 1990;90(9):463-4.
24. Pennec Y, Youinou P, Le Goff P, Boles JM, Le Menn G. Comparison of the manifestations of acute sarcoid arthritis with and without erythema nodosum. Immunopathogenic significance. Scand J Rheumatol. 1982;11(1):13-6.doi: 10.3109/03009748209098106.
25. Semiz H, Kobak S. Coexistence of Sarcoidosis and Gouty Arthritis. Reumatol Clin (Engl Ed). 2019;15(6):e105-e7.doi: 10.1016/j.reuma.2017.07.009.
26. Chatham W. Rheumatic manifestations of systemic disease: sarcoidosis. Curr Opin Rheumatol. 2010;22(1):85-90.doi: 10.1097/BOR.0b013e328333ba74.
27. Shorr AF, Murphy FT, Gilliland WR, Hnatiuk W. Osseous disease in patients with pulmonary sarcoidosis and musculoskeletal symptoms. Respir Med. 2000;94(3):228-32.doi: 10.1053/rmed.1999.0709.
28. Marcoval J, Mañá J, Rubio M. Specific cutaneous lesions in patients with systemic sarcoidosis: relationship to severity and chronicity of disease. Clinical and experimental dermatology. 2011;36(7):739-44.
29. Haimovic A, Sanchez M, Judson MA, Prystowsky S. Sarcoidosis: a comprehensive review and update for the dermatologist: part I. Cutaneous disease. J Am Acad Dermatol. 2012;66(5):699.e1-18; quiz 717-8.doi: 10.1016/j.jaad.2011.11.965.
30. Ishikawa M, Yamamoto T. Erythema nodosum-like sarcoid lesion: a specific skin manifestation occasionally seen in Japanese sarcoidosis patients. Sarcoidosis Vasc Diffuse Lung Dis. 2022;39(1):e2022013.doi: 10.36141/svdld.v39i1.8580.
31. Musellim B, Kumbasar OO, Ongen G, Cetinkaya E, Turker H, Uzaslan E, et al. Epidemiological features of Turkish patients with sarcoidosis. Respir Med. 2009;103(6):907-12.doi: 10.1016/j.rmed.2008.12.011.
32. Yanardag H, Pamuk ON, Pamuk GE. Lupus pernio in sarcoidosis: clinical features and treatment outcomes of 14 patients. J Clin Rheumatol. 2003;9(2):72-6.doi: 10.1097/01.RHU.0000062509.01658.d1.
33. Jamilloux Y, Kodjikian L, Broussolle C, Sève P. Sarcoidosis and uveitis. Autoimmun Rev. 2014;13(8):840-9.doi: 10.1016/j.autrev.2014.04.001.
34. Ma SP, Rogers SL, Hall AJ, Hodgson L, Brennan J, Stawell RJ, et al. Sarcoidosis-related Uveitis: Clinical Presentation, Disease Course, and Rates of Systemic Disease Progression After Uveitis Diagnosis. Am J Ophthalmol. 2019;198:30-6.doi: 10.1016/j.ajo.2018.09.013.
35. Atmaca LS, Atmaca-Sönmez P, Idil A, Kumbasar OO, Celik G. Ocular involvement in sarcoidosis. Ocul Immunol Inflamm. 2009;17(2):91-4.doi: 10.1080/09273940802596526.
36. Dana MR, Merayo-Lloves J, Schaumberg DA, Foster CS. Prognosticators for visual outcome in sarcoid uveitis. Ophthalmology. 1996;103(11):1846-53.doi: 10.1016/s0161-6420(96)30417-x.
37. Mochizuki M, Smith JR, Takase H, Kaburaki T, Acharya NR, Rao NA. Revised criteria of International Workshop on Ocular Sarcoidosis (IWOS) for the diagnosis of ocular sarcoidosis. Br J Ophthalmol. 2019;103(10):1418-22.doi: 10.1136/bjophthalmol-2018-313356.
38. de Prost N, Kerrou K, Sibony M, Talbot JN, Wislez M, Cadranel J. Fluorine-18 fluorodeoxyglucose with positron emission tomography revealed bone marrow involvement in sarcoidosis patients with anaemia. Respiration. 2010;79(1):25-31.doi: 10.1159/000204901.
39. McDonnell MJ, Saleem MI, Wall D, Gilmartin JJ, Rutherford RM, O'Regan A. Predictive value of C-reactive protein and clinically relevant baseline variables in sarcoidosis. Sarcoidosis Vasc Diffuse Lung Dis. 2016;33(4):331-40.
40. Yanardağ H, Pamuk GE, Karayel T, Demirci S. Bone marrow involvement in sarcoidosis: an analysis of 50 bone marrow samples. Haematologia (Budap). 2002;32(4):419-25.
41. Cameli P, Caffarelli C, Refini RM, Bergantini L, d'Alessandro M, Armati M, et al. Hypercalciuria in Sarcoidosis: A Specific Biomarker With Clinical Utility. Front Med (Lausanne). 2020;7:568020.doi: 10.3389/fmed.2020.568020.
42. Studdy PR, Bird R, Neville E, James DG. Biochemical findings in sarcoidosis. J Clin Pathol. 1980;33(6):528-33.doi: 10.1136/jcp.33.6.528.
43. Baughman RP, Janovcik J, Ray M, Sweiss N, Lower EE. Calcium and vitamin D metabolism in sarcoidosis. Sarcoidosis Vasc Diffuse Lung Dis. 2013;30(2):113-20.
44. Gwadera Ł, Białas AJ, Iwański MA, Górski P, Piotrowski WJ. Sarcoidosis and calcium homeostasis disturbances-Do we know where we stand? Chron Respir Dis. 2019;16:1479973119878713.doi: 10.1177/1479973119878713.
45. Studdy PR, Bird R. Serum angiotensin converting enzyme in sarcoidosis--its value in present clinical practice. Ann Clin Biochem. 1989;26 ( Pt 1):13-8.doi: 10.1177/000456328902600102.
46. Ungprasert P, Carmona EM, Crowson CS, Matteson EL. Diagnostic Utility of Angiotensin-Converting Enzyme in Sarcoidosis: A Population-Based Study. Lung. 2016;194(1):91-5.doi: 10.1007/s00408-015-9826-3.
47. Hoitsma E, Drent M, Sharma OP. A pragmatic approach to diagnosing and treating neurosarcoidosis in the 21st century. Curr Opin Pulm Med. 2010;16(5):472-9.doi: 10.1097/MCP.0b013e32833c86df.
48. Baughman RP, Lower EE. Treatment of Sarcoidosis. Clin Rev Allergy Immunol. 2015;49(1):79-92.doi: 10.1007/s12016-015-8492-9.
49. Tripipitsiriwat A, Komoltri C, Ruangchira-Urai R, Ungprasert P. Clinical Characteristics of Sarcoidosis in Asian Population: A 14-year Single Center Retrospective Cohort Study from Thailand. Sarcoidosis Vasc Diffuse Lung Dis. 2020;37(4):e2020011.doi: 10.36141/svdld.v37i4.10136.
50. Al-Kofahi K, Korsten P, Ascoli C, Virupannavar S, Mirsaeidi M, Chang I, et al. Management of extrapulmonary sarcoidosis: challenges and solutions. Ther Clin Risk Manag. 2016;12:1623-34.doi: 10.2147/tcrm.s74476.
51. Hammam N, Evans M, Morgan E, Reimold A, Anastasiou C, Kay JL, et al. Treatment of Sarcoidosis in US Rheumatology Practices: Data From the American College of Rheumatology's Rheumatology Informatics System for Effectiveness (RISE) Registry. Arthritis Care Res (Hoboken). 2022;74(3):371-6.doi: 10.1002/acr.24496.74(3):371-6.
2. Grunewald J, Grutters JC, Arkema EV, Saketkoo LA, Moller DR, Müller-Quernheim J. Sarcoidosis. Nat Rev Dis Primers. 2019;5(1):45.doi: 10.1038/s41572-019-0096-x.
3. Rossi G, Cavazza A, Colby TV. Pathology of Sarcoidosis. Clin Rev Allergy Immunol. 2015;49(1):36-44.doi: 10.1007/s12016-015-8479-6.
4. Teirstein AS, Judson MA, Baughman RP, Rossman MD, Yeager H, Jr., Moller DR. The spectrum of biopsy sites for the diagnosis of sarcoidosis. Sarcoidosis Vasc Diffuse Lung Dis. 2005;22(2):139-46.
5. Judson MA. The Clinical Features of Sarcoidosis: A Comprehensive Review. Clin Rev Allergy Immunol. 2015;49(1):63-78.doi: 10.1007/s12016-014-8450-y.
6. Lopez-Sublet M, Caratti di Lanzacco L, Danser AHJ, Lambert M, Elourimi G, Persu A. Focus on increased serum angiotensin-converting enzyme level: From granulomatous diseases to genetic mutations. Clin Biochem. 2018;59:1-8.doi: 10.1016/j.clinbiochem.2018.06.010.
7. Gerke AK, Hunninghake G. The immunology of sarcoidosis. Clin Chest Med. 2008;29(3):379-90, vii.doi: 10.1016/j.ccm.2008.03.014.
8. Burke RR, Rybicki BA, Rao DS. Calcium and vitamin D in sarcoidosis: how to assess and manage. Semin Respir Crit Care Med. 2010;31(4):474-84.doi: 10.1055/s-0030-1262215.
9. Ungprasert P, Carmona EM, Utz JP, Ryu JH, Crowson CS, Matteson EL. Epidemiology of Sarcoidosis 1946-2013: A Population-Based Study. Mayo Clin Proc. 2016;91(2):183-8.doi: 10.1016/j.mayocp.2015.10.024.
10. Baughman RP, Teirstein AS, Judson MA, Rossman MD, Yeager H, Jr., Bresnitz EA, et al. Clinical characteristics of patients in a case control study of sarcoidosis. Am J Respir Crit Care Med. 2001;164(10 Pt 1):1885-9.doi: 10.1164/ajrccm.164.10.2104046.
11. Rizzato G, Palmieri G, Agrati AM, Zanussi C. The organ-specific extrapulmonary presentation of sarcoidosis: a frequent occurrence but a challenge to an early diagnosis. A 3-year-long prospective observational study. Sarcoidosis Vasc Diffuse Lung Dis. 2004;21(2):119-26.
12. James WE, Koutroumpakis E, Saha B, Nathani A, Saavedra L, Yucel RM, et al. Clinical Features of Extrapulmonary Sarcoidosis Without Lung Involvement. Chest. 2018;154(2):349-56.doi: 10.1016/j.chest.2018.02.003.
13. Valeyre D, Jeny F, Rotenberg C, Bouvry D, Uzunhan Y, Sève P, et al. How to Tackle the Diagnosis and Treatment in the Diverse Scenarios of Extrapulmonary Sarcoidosis. Adv Ther. 2021;38(9):4605-27.doi: 10.1007/s12325-021-01832-5.
14. Sweiss NJ, Patterson K, Sawaqed R, Jabbar U, Korsten P, Hogarth K, et al. Rheumatologic manifestations of sarcoidosis. Semin Respir Crit Care Med. 2010;31(4):463-73.doi: 10.1055/s-0030-1262214.
15. Kobak S, Sever F, Sivrikoz ON, Orman M. Sarcoidois: is it only a mimicker of primary rheumatic disease? A single center experience. Ther Adv Musculoskelet Dis. 2014;6(1):3-7.doi: 10.1177/1759720x13511197.
16. Rana GD, d'Alessandro M, Rizzi L, Bergantini L, Cameli P, Vozza A, et al. Clinical phenotyping in sarcoidosis management. Sarcoidosis Vasc Diffuse Lung Dis. 2021;38(2):e2021007.doi: 10.36141/svdld.v38i2.10423.
17. Judson MA, Costabel U, Drent M, Wells A, Maier L, Koth L, et al. The WASOG Sarcoidosis Organ Assessment Instrument: An update of a previous clinical tool. Sarcoidosis Vasc Diffuse Lung Dis. 2014;31(1):19-27.
18. Pelzer T, Jung P. [Pulmonary and Cardiac Sarcoidosis - Diagnosis and Therapy]. Dtsch Med Wochenschr. 2021;146(5):335-43.doi:10.1055/a-1239-4492.
19. Crouser ED, Maier LA, Wilson KC, Bonham CA, Morgenthau AS, Patterson KC, et al. Diagnosis and Detection of Sarcoidosis. An Official American Thoracic Society Clinical Practice Guideline. Am J Respir Crit Care Med. 2020;201(8):e26-e51.doi: 10.1164/rccm.202002-0251ST.
20. Bickett AN, Lower EE, Baughman RP. Sarcoidosis Diagnostic Score: A Systematic Evaluation to Enhance the Diagnosis of Sarcoidosis. Chest. 2018;154(5):1052-60.doi: 10.1016/j.chest.2018.05.003.
21. Pettersson T. Sarcoid and erythema nodosum arthropathies. Baillieres Best Pract Res Clin Rheumatol. 2000;14(3):461-76.doi: 10.1053/berh.2000.0088.
22. Visser H, Vos K, Zanelli E, Verduyn W, Schreuder GM, Speyer I, et al. Sarcoid arthritis: clinical characteristics, diagnostic aspects, and risk factors. Ann Rheum Dis. 2002;61(6):499-504.doi: 10.1136/ard.61.6.499.
23. Kaufman LD. Lofgren's syndrome (acute sarcoidosis) sine erythema nodosum mimicking acute rheumatoid arthritis. N Y State J Med. 1990;90(9):463-4.
24. Pennec Y, Youinou P, Le Goff P, Boles JM, Le Menn G. Comparison of the manifestations of acute sarcoid arthritis with and without erythema nodosum. Immunopathogenic significance. Scand J Rheumatol. 1982;11(1):13-6.doi: 10.3109/03009748209098106.
25. Semiz H, Kobak S. Coexistence of Sarcoidosis and Gouty Arthritis. Reumatol Clin (Engl Ed). 2019;15(6):e105-e7.doi: 10.1016/j.reuma.2017.07.009.
26. Chatham W. Rheumatic manifestations of systemic disease: sarcoidosis. Curr Opin Rheumatol. 2010;22(1):85-90.doi: 10.1097/BOR.0b013e328333ba74.
27. Shorr AF, Murphy FT, Gilliland WR, Hnatiuk W. Osseous disease in patients with pulmonary sarcoidosis and musculoskeletal symptoms. Respir Med. 2000;94(3):228-32.doi: 10.1053/rmed.1999.0709.
28. Marcoval J, Mañá J, Rubio M. Specific cutaneous lesions in patients with systemic sarcoidosis: relationship to severity and chronicity of disease. Clinical and experimental dermatology. 2011;36(7):739-44.
29. Haimovic A, Sanchez M, Judson MA, Prystowsky S. Sarcoidosis: a comprehensive review and update for the dermatologist: part I. Cutaneous disease. J Am Acad Dermatol. 2012;66(5):699.e1-18; quiz 717-8.doi: 10.1016/j.jaad.2011.11.965.
30. Ishikawa M, Yamamoto T. Erythema nodosum-like sarcoid lesion: a specific skin manifestation occasionally seen in Japanese sarcoidosis patients. Sarcoidosis Vasc Diffuse Lung Dis. 2022;39(1):e2022013.doi: 10.36141/svdld.v39i1.8580.
31. Musellim B, Kumbasar OO, Ongen G, Cetinkaya E, Turker H, Uzaslan E, et al. Epidemiological features of Turkish patients with sarcoidosis. Respir Med. 2009;103(6):907-12.doi: 10.1016/j.rmed.2008.12.011.
32. Yanardag H, Pamuk ON, Pamuk GE. Lupus pernio in sarcoidosis: clinical features and treatment outcomes of 14 patients. J Clin Rheumatol. 2003;9(2):72-6.doi: 10.1097/01.RHU.0000062509.01658.d1.
33. Jamilloux Y, Kodjikian L, Broussolle C, Sève P. Sarcoidosis and uveitis. Autoimmun Rev. 2014;13(8):840-9.doi: 10.1016/j.autrev.2014.04.001.
34. Ma SP, Rogers SL, Hall AJ, Hodgson L, Brennan J, Stawell RJ, et al. Sarcoidosis-related Uveitis: Clinical Presentation, Disease Course, and Rates of Systemic Disease Progression After Uveitis Diagnosis. Am J Ophthalmol. 2019;198:30-6.doi: 10.1016/j.ajo.2018.09.013.
35. Atmaca LS, Atmaca-Sönmez P, Idil A, Kumbasar OO, Celik G. Ocular involvement in sarcoidosis. Ocul Immunol Inflamm. 2009;17(2):91-4.doi: 10.1080/09273940802596526.
36. Dana MR, Merayo-Lloves J, Schaumberg DA, Foster CS. Prognosticators for visual outcome in sarcoid uveitis. Ophthalmology. 1996;103(11):1846-53.doi: 10.1016/s0161-6420(96)30417-x.
37. Mochizuki M, Smith JR, Takase H, Kaburaki T, Acharya NR, Rao NA. Revised criteria of International Workshop on Ocular Sarcoidosis (IWOS) for the diagnosis of ocular sarcoidosis. Br J Ophthalmol. 2019;103(10):1418-22.doi: 10.1136/bjophthalmol-2018-313356.
38. de Prost N, Kerrou K, Sibony M, Talbot JN, Wislez M, Cadranel J. Fluorine-18 fluorodeoxyglucose with positron emission tomography revealed bone marrow involvement in sarcoidosis patients with anaemia. Respiration. 2010;79(1):25-31.doi: 10.1159/000204901.
39. McDonnell MJ, Saleem MI, Wall D, Gilmartin JJ, Rutherford RM, O'Regan A. Predictive value of C-reactive protein and clinically relevant baseline variables in sarcoidosis. Sarcoidosis Vasc Diffuse Lung Dis. 2016;33(4):331-40.
40. Yanardağ H, Pamuk GE, Karayel T, Demirci S. Bone marrow involvement in sarcoidosis: an analysis of 50 bone marrow samples. Haematologia (Budap). 2002;32(4):419-25.
41. Cameli P, Caffarelli C, Refini RM, Bergantini L, d'Alessandro M, Armati M, et al. Hypercalciuria in Sarcoidosis: A Specific Biomarker With Clinical Utility. Front Med (Lausanne). 2020;7:568020.doi: 10.3389/fmed.2020.568020.
42. Studdy PR, Bird R, Neville E, James DG. Biochemical findings in sarcoidosis. J Clin Pathol. 1980;33(6):528-33.doi: 10.1136/jcp.33.6.528.
43. Baughman RP, Janovcik J, Ray M, Sweiss N, Lower EE. Calcium and vitamin D metabolism in sarcoidosis. Sarcoidosis Vasc Diffuse Lung Dis. 2013;30(2):113-20.
44. Gwadera Ł, Białas AJ, Iwański MA, Górski P, Piotrowski WJ. Sarcoidosis and calcium homeostasis disturbances-Do we know where we stand? Chron Respir Dis. 2019;16:1479973119878713.doi: 10.1177/1479973119878713.
45. Studdy PR, Bird R. Serum angiotensin converting enzyme in sarcoidosis--its value in present clinical practice. Ann Clin Biochem. 1989;26 ( Pt 1):13-8.doi: 10.1177/000456328902600102.
46. Ungprasert P, Carmona EM, Crowson CS, Matteson EL. Diagnostic Utility of Angiotensin-Converting Enzyme in Sarcoidosis: A Population-Based Study. Lung. 2016;194(1):91-5.doi: 10.1007/s00408-015-9826-3.
47. Hoitsma E, Drent M, Sharma OP. A pragmatic approach to diagnosing and treating neurosarcoidosis in the 21st century. Curr Opin Pulm Med. 2010;16(5):472-9.doi: 10.1097/MCP.0b013e32833c86df.
48. Baughman RP, Lower EE. Treatment of Sarcoidosis. Clin Rev Allergy Immunol. 2015;49(1):79-92.doi: 10.1007/s12016-015-8492-9.
49. Tripipitsiriwat A, Komoltri C, Ruangchira-Urai R, Ungprasert P. Clinical Characteristics of Sarcoidosis in Asian Population: A 14-year Single Center Retrospective Cohort Study from Thailand. Sarcoidosis Vasc Diffuse Lung Dis. 2020;37(4):e2020011.doi: 10.36141/svdld.v37i4.10136.
50. Al-Kofahi K, Korsten P, Ascoli C, Virupannavar S, Mirsaeidi M, Chang I, et al. Management of extrapulmonary sarcoidosis: challenges and solutions. Ther Clin Risk Manag. 2016;12:1623-34.doi: 10.2147/tcrm.s74476.
51. Hammam N, Evans M, Morgan E, Reimold A, Anastasiou C, Kay JL, et al. Treatment of Sarcoidosis in US Rheumatology Practices: Data From the American College of Rheumatology's Rheumatology Informatics System for Effectiveness (RISE) Registry. Arthritis Care Res (Hoboken). 2022;74(3):371-6.doi: 10.1002/acr.24496.74(3):371-6.
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Konak HE, Güven SC, Atalar E, Akyüz Dağlı P, Koçak Ulucaköy R, Kayacn Erdoğan E, et al. A single-center rheumatology experience of sarcoidosis: observations from 70 patients. Sarcoidosis Vasc Diffuse Lung Dis [Internet]. 2023 Sep. 13 [cited 2024 Jul. 18];40(3):e2023033. Available from: https://mattioli1885journals.com/index.php/sarcoidosis/article/view/14063
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How to Cite
1.
Konak HE, Güven SC, Atalar E, Akyüz Dağlı P, Koçak Ulucaköy R, Kayacn Erdoğan E, et al. A single-center rheumatology experience of sarcoidosis: observations from 70 patients. Sarcoidosis Vasc Diffuse Lung Dis [Internet]. 2023 Sep. 13 [cited 2024 Jul. 18];40(3):e2023033. Available from: https://mattioli1885journals.com/index.php/sarcoidosis/article/view/14063
