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Sarcoid arthropathy

Winston Sequeira, MD
Rohit Aggarwal, MD, MSc
Section Editor
Peter H Schur, MD
Deputy Editor
Paul L Romain, MD


Sarcoidosis, a multisystem disorder of unknown etiology, is characterized pathologically by the presence of noncaseating granulomas in affected organs (see "Pathogenesis of sarcoidosis"). It typically affects young adults, and, although any organ may be affected, the disorder commonly presents with one or more of the following three abnormalities:

Bilateral hilar adenopathy

Pulmonary infiltrates

Skin and/or eye lesions

Musculoskeletal disease is a less common problem. However, joint manifestations may be clinically significant in patients with acute disease, such as acute arthritis with hilar lymphadenopathy and/or erythema nodosum [1]. Chronic arthritis and other musculoskeletal manifestations may also occur.


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Literature review current through: Sep 2016. | This topic last updated: Sep 22, 2016.
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  1. Ungprasert P, Crowson CS, Matteson EL. Clinical Characteristics of Sarcoid Arthropathy: A Population-Based Study. Arthritis Care Res (Hoboken) 2016; 68:695.
  2. Abril A, Cohen MD. Rheumatologic manifestations of sarcoidosis. Curr Opin Rheumatol 2004; 16:51.
  3. Visser H, Vos K, Zanelli E, et al. Sarcoid arthritis: clinical characteristics, diagnostic aspects, and risk factors. Ann Rheum Dis 2002; 61:499.
  4. Baughman RP, Teirstein AS, Judson MA, et al. Clinical characteristics of patients in a case control study of sarcoidosis. Am J Respir Crit Care Med 2001; 164:1885.
  5. Sharma SK, Soneja M, Sharma A, et al. Rare manifestations of sarcoidosis in modern era of new diagnostic tools. Indian J Med Res 2012; 135:621.
  6. Johard U, Eklund A. Recurrent Löfgren's syndrome in three patients with sarcoidosis. Sarcoidosis 1993; 10:125.
  7. Mañá J, Gómez-Vaquero C, Montero A, et al. Löfgren's syndrome revisited: a study of 186 patients. Am J Med 1999; 107:240.
  8. Grunewald J, Eklund A. Sex-specific manifestations of Löfgren's syndrome. Am J Respir Crit Care Med 2007; 175:40.
  9. Glennås A, Kvien TK, Melby K, et al. Acute sarcoid arthritis: occurrence, seasonal onset, clinical features and outcome. Br J Rheumatol 1995; 34:45.
  10. Kaufman LD. Lofgren's syndrome (acute sarcoidosis) sine erythema nodosum mimicking acute rheumatoid arthritis. N Y State J Med 1990; 90:463.
  11. Pennec Y, Youinou P, Le Goff P, et al. Comparison of the manifestations of acute sarcoid arthritis with and without erythema nodosum. Immunopathogenic significance. Scand J Rheumatol 1982; 11:13.
  12. Shetty AK, Gedalia A. Sarcoidosis: a pediatric perspective. Clin Pediatr (Phila) 1998; 37:707.
  13. Kremer JM. Histologic findings in siblings with acute sarcoid arthritis: association with the B8,DR3 phenotype. J Rheumatol 1986; 13:593.
  14. Sato H, Grutters JC, Pantelidis P, et al. HLA-DQB1*0201: a marker for good prognosis in British and Dutch patients with sarcoidosis. Am J Respir Cell Mol Biol 2002; 27:406.
  15. Spagnolo P, Renzoni EA, Wells AU, et al. C-C chemokine receptor 2 and sarcoidosis: association with Lofgren's syndrome. Am J Respir Crit Care Med 2003; 168:1162.
  16. Grunewald J, Eklund A. Löfgren's syndrome: human leukocyte antigen strongly influences the disease course. Am J Respir Crit Care Med 2009; 179:307.
  17. Torralba KD, Quismorio FP Jr. Sarcoid arthritis: a review of clinical features, pathology and therapy. Sarcoidosis Vasc Diffuse Lung Dis 2003; 20:95.
  18. Sequeira W, Stinar D. Serum angiotensin-converting enzyme levels in sarcoid arthritis. Arch Intern Med 1986; 146:125.
  19. Muthuswamy PP, Lopez-Majano V, Ranginwala M, Trainor WD. Serum angiotensin-converting enzyme (SACE) activity as an indicator of total body granuloma load and prognosis in sarcoidosis. Sarcoidosis 1987; 4:142.
  20. Sukenik S, Hendler N, Yerushalmi B, et al. Jaccoud's-type arthropathy: an association with sarcoidosis. J Rheumatol 1991; 18:915.
  21. Rothschild BM, Pingitore C, Eaton M. Dactylitis: implications for clinical practice. Semin Arthritis Rheum 1998; 28:41.
  22. Thelier N, Assous N, Job-Deslandre C, et al. Osteoarticular involvement in a series of 100 patients with sarcoidosis referred to rheumatology departments. J Rheumatol 2008; 35:1622.
  23. Griep EN, van Spiegel PI, van Soesbergen RM. Sarcoidosis accompanied by pulmonary tuberculosis and complicated by sacroiliitis. Arthritis Rheum 1993; 36:716.
  24. Harvey JA, Pak CY. Gouty diathesis and sarcoidosis in patient with recurrent calcium nephrolithiasis. J Urol 1988; 139:1287.
  25. Zimmer JG, Demis DJ. Associations between gout, psoriasis, and sarcoidosis with consideration of their pathogenic significance. Ann Intern Med 1966; 64:786.
  27. Huskisson EC, Balme HW. Pseudopodagra. Differential diagnosis of gout. Lancet 1972; 2:269.
  28. Crowder SW, Jaffey LH. Sarcoidosis presenting as Achilles tendinitis. J R Soc Med 1995; 88:335.
  29. Larsen TK. Tenosynovitis as initial diagnosis of sarcoidosis. Case report. Scand J Plast Reconstr Surg Hand Surg 1996; 30:157.
  30. Katzman BM, Caligiuri DA, Klein DM, et al. Sarcoid flexor tenosynovitis of the wrist: a case report. J Hand Surg Am 1997; 22:336.
  31. Kellner H, Späthling S, Herzer P. Ultrasound findings in Löfgren's syndrome: is ankle swelling caused by arthritis, tenosynovitis or periarthritis? J Rheumatol 1992; 19:38.
  32. Palmer DG, Schumacher HR. Synovitis with non-specific histological changes in synovium in chronic sarcoidosis. Ann Rheum Dis 1984; 43:778.
  33. Awada H, Abi-Karam G, Fayad F. Musculoskeletal and other extrapulmonary disorders in sarcoidosis. Best Pract Res Clin Rheumatol 2003; 17:971.
  34. Varkey B. Letter: Synovial fluid in sarcoid arthritis. Ann Intern Med 1974; 81:557.
  35. Le Bras E, Ehrenstein B, Fleck M, Hartung W. Evaluation of ankle swelling due to Lofgren's syndrome: a pilot study using B-mode and power Doppler ultrasonography. Arthritis Care Res (Hoboken) 2014; 66:318.
  36. Moore SL, Teirstein AE. Musculoskeletal sarcoidosis: spectrum of appearances at MR imaging. Radiographics 2003; 23:1389.
  37. Iannuzzi MC, Rybicki BA, Teirstein AS. Sarcoidosis. N Engl J Med 2007; 357:2153.
  38. Isdale AH, Iveson JM. Synovial cysts and sarcoid synovitis. Br J Rheumatol 1992; 31:497.
  39. Scott DG, Porto LO, Lovell CR, Thomas GO. Chronic sarcoid synovitis in the Caucasian: an arthroscopic and histological study. Ann Rheum Dis 1981; 40:121.
  40. Pettersson T. Rheumatic features of sarcoidosis. Curr Opin Rheumatol 1998; 10:73.
  41. Kobak S. Sarcoidosis: a rheumatologist's perspective. Ther Adv Musculoskelet Dis 2015; 7:196.
  42. KAPLAN H. SARCOID ARTHRITIS. A REVIEW. Arch Intern Med 1963; 112:924.
  43. Fitzgerald AA, Davis P. Arthritis, hilar adenopathy, erythema nodosum complex. J Rheumatol 1982; 9:935.
  44. Baughman RP, Lower EE. Steroid-sparing alternative treatments for sarcoidosis. Clin Chest Med 1997; 18:853.
  45. KAPLAN H. Sarcoid arthritis with a response to colchicine: report of two cases. N Engl J Med 1960; 263:778.
  46. Kaye O, Palazzo E, Grossin M, et al. Low-dose methotrexate: an effective corticosteroid-sparing agent in the musculoskeletal manifestations of sarcoidosis. Br J Rheumatol 1995; 34:642.
  47. Khanna D, Liebling MR, Louie JS. Etanercept ameliorates sarcoidosis arthritis and skin disease. J Rheumatol 2003; 30:1864.
  48. Hobbs K. Chronic sarcoid arthritis treated with intraarticular etanercept. Arthritis Rheum 2005; 52:987.
  49. Judson MA, Baughman RP, Costabel U, et al. Efficacy of infliximab in extrapulmonary sarcoidosis: results from a randomised trial. Eur Respir J 2008; 31:1189.
  50. Ulbricht KU, Stoll M, Bierwirth J, et al. Successful tumor necrosis factor alpha blockade treatment in therapy-resistant sarcoidosis. Arthritis Rheum 2003; 48:3542.
  51. Sweiss NJ, Welsch MJ, Curran JJ, Ellman MH. Tumor necrosis factor inhibition as a novel treatment for refractory sarcoidosis. Arthritis Rheum 2005; 53:788.
  52. Moller DR. Treatment of sarcoidosis -- from a basic science point of view. J Intern Med 2003; 253:31.
  53. Utz JP, Limper AH, Kalra S, et al. Etanercept for the treatment of stage II and III progressive pulmonary sarcoidosis. Chest 2003; 124:177.
  54. Baughman RP, Lower EE, Bradley DA, et al. Etanercept for refractory ocular sarcoidosis: results of a double-blind randomized trial. Chest 2005; 128:1062.
  55. Baughman RP, Drent M, Kavuru M, et al. Infliximab therapy in patients with chronic sarcoidosis and pulmonary involvement. Am J Respir Crit Care Med 2006; 174:795.
  56. Rossman MD, Newman LS, Baughman RP, et al. A double-blinded, randomized, placebo-controlled trial of infliximab in subjects with active pulmonary sarcoidosis. Sarcoidosis Vasc Diffuse Lung Dis 2006; 23:201.
  57. Sweiss NJ, Noth I, Mirsaeidi M, et al. Efficacy Results of a 52-week Trial of Adalimumab in the Treatment of Refractory Sarcoidosis. Sarcoidosis Vasc Diffuse Lung Dis 2014; 31:46.
  58. Pariser RJ, Paul J, Hirano S, et al. A double-blind, randomized, placebo-controlled trial of adalimumab in the treatment of cutaneous sarcoidosis. J Am Acad Dermatol 2013; 68:765.
  59. Massara A, Cavazzini L, La Corte R, Trotta F. Sarcoidosis appearing during anti-tumor necrosis factor alpha therapy: a new "class effect" paradoxical phenomenon. Two case reports and literature review. Semin Arthritis Rheum 2010; 39:313.
  60. Limbird TJ. Arthroscopic synovectomy in sarcoid synovitis. Arthroscopy 1993; 9:599.