Carlotta Cacciatore1, Pierre Belnou2, Sara Thietart1, Carole Desthieux1, Mathilde Versini3, Noemie Abisror1, Sébastien Ottaviani4, Gregoire Cormier5, Alban Deroux6, Azeddine Dellal7, Nicolas Belhomme8, Nathalie Saidenberg Kermanac'H9,10, Philippe Khafagy11, Martin Michaud12, Sylvain Lanot13, Fabrice Carrat2,14, Olivier Fain1, Arsène Mékinian1. 1. Sorbonne Université, Service de médecine interne, Hôpital Saint-Antoine, DHU I2B: Inflammation, Immunopathologie, Biothérapie, APHP, Paris, France. 2. Sorbonne Université, Service de santé publique, Hôpital Saint-Antoine, APHP, Paris, France. 3. Service de Médecine interne, Centre Hospitalier Universitaire de Nice, Nice, France. 4. Service de rhumatologie, Hôpital Bichat, APHP, Paris, France. 5. Service de rhumatologie, CHD Vendée, La Roche-sur-Yon, France. 6. Service de médecine interne, CHU Grenoble, La Tronche, France. 7. Service de rhumatologie, Hôpital Montfermeil, Montfermeil, France. 8. Service de médecine interne et immunologie clinique, CHU Rennes, Rennes, France. 9. Service de rhumatologie, Groupe hospitalier Avicenne-Jean Verdier-René Muret, APHP, Bobigny, France. 10. Sorbonne Paris Cité, Université Paris 13, INSERM U1125, Bobigny, France. 11. Service de radiologie, Hôpital Montfermeil, Montfermeil, France. 12. Service de médecine interne, Hôpital Joseph Ducuing, Toulouse, France. 13. Service de rhumatologie, C.H intercommunal Alençon-Mamers, Alençon, France. 14. Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Paris, France.
Abstract
Introduction: We aimed to analyze patients with acute and chronic joint involvements in sarcoidosis. Methods: This is a retrospective multicenter analysis of patients with proven sarcoidosis, as defined by clinical, radiological, and histological criteria, with at least one clinical and/or ultrasonographic synovitis. Results: Thirty-nine patients with sarcoid arthropathy were included, and among them 19 had acute sarcoidosis (Lofgren's syndrome). Joint involvement and DAS44-CRP were not significantly different in acute and chronic sarcoid arthropathies. Acute forms were more frequent than chronic sarcoid arthropathy in Caucasians, without any difference of sex or age between these 2 forms. Joint involvement was frequently more symmetrical in acute than chronic forms (100 vs. 70%; p < 0.05), with a more frequent involvement in wrists and ankles in acute forms, whereas the tender and swollen joint counts and the DAS44-CRP were similar between the 2 groups. Skin lesions were significantly more frequent in patients with acute forms [17 (89%) vs. 5 (25%); p < 0.05] and were erythema nodosum in all patients with Löfgren's syndrome and sarcoid skin lesions in those with chronic sarcoidosis. Among 20 patients with chronic sarcoidosis, treatment was used in 17 (85%) cases, and consisted in NSAIDs alone (n = 5; 25%), steroids alone (n = 5; 25%), hydroxychloroquine (n = 2; 20%), methotrexate (n = 3; 15%), and TNF inhibitors (n = 2; 10%). A complete/partial joint response was noted in 14 (70%) cases with a DAS44-CRP reduction of 2.07 [1.85-2.44] (from 3.13 [2.76-3.42] to 1.06 [0.9-1.17]; p < 0.05). Conclusion: Sarcoid arthropathies have different clinical phenotypes in acute and chronic forms and various treatment regimens such as hydroxychloroquine and methotrexate could be used in chronic forms.
Introduction: We aimed to analyze patients with acute and chronic joint involvements in sarcoidosis. Methods: This is a retrospective multicenter analysis of patients with proven sarcoidosis, as defined by clinical, radiological, and histological criteria, with at least one clinical and/or ultrasonographic synovitis. Results: Thirty-nine patients with sarcoid arthropathy were included, and among them 19 had acute sarcoidosis (Lofgren's syndrome). Joint involvement and DAS44-CRP were not significantly different in acute and chronic sarcoid arthropathies. Acute forms were more frequent than chronic sarcoid arthropathy in Caucasians, without any difference of sex or age between these 2 forms. Joint involvement was frequently more symmetrical in acute than chronic forms (100 vs. 70%; p < 0.05), with a more frequent involvement in wrists and ankles in acute forms, whereas the tender and swollen joint counts and the DAS44-CRP were similar between the 2 groups. Skin lesions were significantly more frequent in patients with acute forms [17 (89%) vs. 5 (25%); p < 0.05] and were erythema nodosum in all patients with Löfgren's syndrome and sarcoid skin lesions in those with chronic sarcoidosis. Among 20 patients with chronic sarcoidosis, treatment was used in 17 (85%) cases, and consisted in NSAIDs alone (n = 5; 25%), steroids alone (n = 5; 25%), hydroxychloroquine (n = 2; 20%), methotrexate (n = 3; 15%), and TNF inhibitors (n = 2; 10%). A complete/partial joint response was noted in 14 (70%) cases with a DAS44-CRP reduction of 2.07 [1.85-2.44] (from 3.13 [2.76-3.42] to 1.06 [0.9-1.17]; p < 0.05). Conclusion:Sarcoid arthropathies have different clinical phenotypes in acute and chronic forms and various treatment regimens such as hydroxychloroquine and methotrexate could be used in chronic forms.
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