Sarcoid and erythema nodosum arthropathies

Sarcoidosis is a systemic granulomatous disease of unknown origin, characte rized in affected organs by an accumulation of activated T lymphocytes and macrophages. Musculoskeletal manifestations of sarcoidosis include acute an d chronic arthritis and muscular and osseous sarcoidosis. In certain popula tions, acute sarcoidosis often presents with constitutional symptoms, polya rthritis and erythema nodosum (Lofgren's syndrome). Erythema nodosum, often with joint symptoms, also occurs in association with several other conditi ons including infections, medications and other underlying diseases. The di agnosis of sarcoidosis should be based on a tissue biopsy, but a patient wi th typical Lofgren's syndrome may not require biopsy proof. Among the long list of biochemical markers that have been suggested as aids for diagnosis and monitoring of sarcoidosis, calcium in serum and urine and angiotensin-c onverting enzyme in serum are well-established clinical tools. Serum angiot ensin-converting enzyme can be used for monitoring disease activity in the individual patient, but because of lack of sensitivity and specificity its diagnostic value is rather low. Non-steroidal anti-inflammatory agents usua lly effectively alleviate acute sarcoid arthritis and joint symptoms associ ated with erythema nodosum. In severe acute arthritis and in chronic arthri tis, corticosteroids may be required to control the symptoms. In patients r equiring persistent corticosteroid therapy, antimalarial agents and methotr exate constitute therapeutic alternatives.