From the Guidelines
Yes, sarcoidosis can cause joint swelling and pain, affecting about 10-15% of patients, with symptoms presenting as acute or chronic arthritis, and treatment depending on severity, often including nonsteroidal anti-inflammatory drugs (NSAIDs) or corticosteroids. This inflammatory condition, which primarily affects the lungs and lymph nodes, can also involve the joints, a manifestation known as sarcoid arthritis. The joint symptoms typically present with swelling, tenderness, and limited range of motion, with the ankles being most commonly affected, followed by knees, wrists, and small joints of the hands and feet 1. The joint pain in sarcoidosis is often symmetrical and may be accompanied by morning stiffness.
Treatment Options
Treatment depends on the severity of the joint involvement, but often includes:
- Nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen (400-800mg three times daily) or naproxen (500mg twice daily) for mild cases
- Corticosteroids such as prednisone (starting at 20-40mg daily and tapering) for more severe joint involvement
- Disease-modifying antirheumatic drugs like methotrexate (10-25mg weekly) or hydroxychloroquine (200mg twice daily) for resistant cases 1.
Pathophysiology
Joint symptoms in sarcoidosis occur because the same inflammatory process that affects other organs can deposit granulomas (clusters of inflammatory cells) in and around the joints, leading to inflammation and pain. The management of sarcoidosis can be challenging, and the clinician must consider the various manifestations both initially and over time, with the outcome of the disease being variable 1.
From the Research
Sarcoidosis and Joint Involvement
- Sarcoidosis is a systemic disorder that can involve various tissues and organs, including the locomotor system, with a reported involvement range of 15% to 25% 2.
- The disease can present with joint swelling or pain, with two major joint involvements described: acute and chronic form 2, 3.
- The acute form of sarcoid arthritis may be the first sign of sarcoidosis and presents with arthralgia, arthritis, or periarthritis, while chronic sarcoid arthritis is usually associated with pulmonary parenchymal disease or other organ involvement and occurs rarely 2, 3.
Clinical Features and Treatment
- Sarcoid arthritis can cause inflammatory arthritis, periarticular soft tissue swelling, tenosynovitis, dactylitis, bone involvement, and myopathy 3.
- The treatment of sarcoidosis-related joint symptoms typically involves nonsteroidal anti-inflammatory drugs and corticosteroids, with immunosuppressive and anti-tumor necrosis factor alpha drugs used in patients unresponsive to corticosteroids 2, 4, 5, 6.
- Corticosteroids are the drug of choice for treating sarcoidosis, but efforts should be made to minimize the corticosteroid dose while keeping the risk of toxicity as low as possible 5.