Case report: sarcoidosis mimicking rheumatoid arthritis or coexistence of both diagnoses
DOI:
https://doi.org/10.55312/op.vi2.6144Abstract
Introduction: Rheumatoid arthritis is one of the most common autoimmune diseases in clinical practice. Although diagnostic criteria are well-defined, it is important to differentiate between other pathologies that resemble it. Sarcoidosis is one of them. Case presentation: A 45-year-old patient diagnosed in one year with seropositive rheumatoid arthritis with inflammatory pain in the small joints of the hands with slightly positive RF, slightly positive ANA, negative anti-CCP under treatment with methotrexate 10 mg/week, prednisone 5 mg/ day, presented to our center due to dexter cervicobrachialgia. It was suggested to get an MRI of the cervical spine, which revealed C4-C5 bulging disk with narrowing of the dexter neuroforamina, as well as cervical lymphadenopathy. Additional imaging examinations revealed generalized lymphadenopathy, and a lymph node biopsy confirmed the diagnosis of sarcoidosis. The patient’s clinical and inflammatory tests improved significantly after starting treatment for sarcoidosis. The question was whether we were dealing with a case of sarcoidosis that mimics arthritis or if both diagnoses are present in the same patient. Conclusion: Even though the rheumatologist meets the criteria for establishing a diagnosis of rheumatoid arthritis, they should consider other clinically similar diseases when making the differential diagnosis, that raises the inflammatory tests, and can easily give positive results for RF and ANA.Keywords:
sarcoidosis, rheumatoid arthritis, lymphadenopathy.Downloads
References
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Aletaha D, Neogi T, Silman AJ, et al 2010 Rheumatoid arthritis classification criteria: an American College of Rheumatology/ European League Against Rheumatism collaborative initiative, Annals of the Rheumatic Diseases, 2010;69:1580-1588.
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Mackenzie, A H. “Differential diagnosis of rheumatoid arthritis.” The American journal of medicine vol. 85, 4A (1988): 2-11.
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Smolen, Josef S et al. “EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs: 2019 update.”, Annals of the rheumatic diseases vol. 79, 6 (2020): 685-699.
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Gary S. Firestein, Ralph C. Budd et al, Firestein and Kelleys textbook of rheumatology, 11th edition, Elsevier, 2021: 1247-1253.
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Gökten DB, Mercan R., Sarcoidosis from the Perspective of Rheumatology: Three Years of Experience, Namik Kemal Med J. 2024 Mar; 12(1):1-7.
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Soto-Gomez, Natalia et al. “Diagnosis and Management of Sarcoidosis.” American family physician vol. 93,10 (2016): 840-8.
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Hasbani GE, Uthman I, Jawad AS. Musculoskeletal Manifestations of Sarcoidosis. Clinical Medicine Insights: Arthritis and Musculoskeletal Disorders. 2022;15
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Sweiss, Nadera J et al. “Rheumatologic manifestations of sarcoidosis.” Seminars in respiratory and critical care medicine vol. 31,4 (2010): 463-73.
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Neves, F.S., Pereira, I.A., Sztajnbok, F. et al. Sarcoidosis: a general overview. Adv Rheumatol 64, 57 (2024).
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Baughman, Robert P et al. “ERS clinical practice guidelines on treatment of sarcoidosis.” The European respiratory journal vol. 58,6 2004079. 16 Dec. 2021
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Kobak, Şenol et al. “Co-occurrence of rheumatoid arthritis and sarcoidosis.” BMJ case reports vol.
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bcr2014208803. 6 Jul. 2015
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Torralba, Karina D, and Francisco P Quismorio Jr. “Sarcoid arthritis: a review of clinical features, pathology and therapy.” Sarcoidosis, vasculitis, and diffuse lung diseases: official journal of WASOG vol. 20, 2 (2003): 95-103.
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Oreskes, Irwin et al. Changes in rheumatoid factor activity during the course of sarcoidosis, TheAmerican Journal of Medicine, Volume 44, Issue 1, 60 – 67.
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Crouser, Elliott D et al. “Diagnosis and Detection of Sarcoidosis. An Official American ThoracicSociety Clinical Practice Guideline.” American journal of respiratory and critical care medicine vol. 201,8 (2020): e26-e51.
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Terence Yeung, Adrian Grebowicz, Tatiana Nevskaya, Sulman Zahid, Janet E Pope, Joint involvement in sarcoidosis: systematic review and meta-analysis of prevalence, clinical pattern and outcome, Rheumatology, 63, 7, 2024; 1803-1814.
References
Aletaha D, Neogi T, Silman AJ, et al 2010 Rheumatoid arthritis classification criteria: an American College of Rheumatology/ European League Against Rheumatism collaborative initiative, Annals of the Rheumatic Diseases, 2010;69:1580-1588.
Mackenzie, A H. “Differential diagnosis of rheumatoid arthritis.” The American journal of medicine vol. 85, 4A (1988): 2-11.
Smolen, Josef S et al. “EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs: 2019 update.”, Annals of the rheumatic diseases vol. 79, 6 (2020): 685-699.
Gary S. Firestein, Ralph C. Budd et al, Firestein and Kelleys textbook of rheumatology, 11th edition, Elsevier, 2021: 1247-1253.
Gökten DB, Mercan R., Sarcoidosis from the Perspective of Rheumatology: Three Years of Experience, Namik Kemal Med J. 2024 Mar; 12(1):1-7.
Soto-Gomez, Natalia et al. “Diagnosis and Management of Sarcoidosis.” American family physician vol. 93,10 (2016): 840-8.
Hasbani GE, Uthman I, Jawad AS. Musculoskeletal Manifestations of Sarcoidosis. Clinical Medicine Insights: Arthritis and Musculoskeletal Disorders. 2022;15
Sweiss, Nadera J et al. “Rheumatologic manifestations of sarcoidosis.” Seminars in respiratory and critical care medicine vol. 31,4 (2010): 463-73.
Neves, F.S., Pereira, I.A., Sztajnbok, F. et al. Sarcoidosis: a general overview. Adv Rheumatol 64, 57 (2024).
Baughman, Robert P et al. “ERS clinical practice guidelines on treatment of sarcoidosis.” The European respiratory journal vol. 58,6 2004079. 16 Dec. 2021
Kobak, Şenol et al. “Co-occurrence of rheumatoid arthritis and sarcoidosis.” BMJ case reports vol.
bcr2014208803. 6 Jul. 2015
Torralba, Karina D, and Francisco P Quismorio Jr. “Sarcoid arthritis: a review of clinical features, pathology and therapy.” Sarcoidosis, vasculitis, and diffuse lung diseases: official journal of WASOG vol. 20, 2 (2003): 95-103.
Oreskes, Irwin et al. Changes in rheumatoid factor activity during the course of sarcoidosis, TheAmerican Journal of Medicine, Volume 44, Issue 1, 60 – 67.
Crouser, Elliott D et al. “Diagnosis and Detection of Sarcoidosis. An Official American ThoracicSociety Clinical Practice Guideline.” American journal of respiratory and critical care medicine vol. 201,8 (2020): e26-e51.
Terence Yeung, Adrian Grebowicz, Tatiana Nevskaya, Sulman Zahid, Janet E Pope, Joint involvement in sarcoidosis: systematic review and meta-analysis of prevalence, clinical pattern and outcome, Rheumatology, 63, 7, 2024; 1803-1814.
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