| Popis: |
Background Sarcoidosis is a systemic granulomatous disease of unknown etiology, mediated by Th1 lymphocytes, characterized by bilateral hilar adenopathies, pulmonary infiltrates, ocular, articular and cutaneous involvement and histologically by noncaseating granulomas. Sarcoidosis can simulate many chronic rheumatic diseases but can also coexist with them, so there are doubts about whether there is a true association or is incidental. Likewise, the occurrence of sarcoidosis has been described as a paradoxical effect during treatment with biological drugs, especially with tumor necrosis factor antagonists possibly due to a dysregulation in the compensatory proinflammatory cascade related of TNF blockade.The association between sarcoidosis and Sjogren’s syndrome, systemic lupus erythematosus, polymyositis, spondyloarthritis, systemic sclerosis (ES) or rheumatoid arthritis (RA) has been reported. Objectives To describe the clinical characteristics of 15 patients with sarcoidosis and chronic inflammatory rheumatic diseases in 6 hospitals of Catalonia. Methods Retrospective descriptive study of patients affected by sarcoidosis and chronic inflammatory rheumatic diseases. The following data were recorded: sex, age, date of diagnosis and clinical characteristics, treatment and evolution of both pathologies. As well as the results of the pulmonary CT, the angiotensin converting enzyme (ACE) and the biopsy results. Results We described 15 patients with sarcoidosis, 6 men and 9 women, median age 58 years (39-84). Five patients had seropositive RA (rheumatoid factor and citrullinated antipeptide antibodies), 2 ankylosing spondylitis, 2 psoriasic arthritis, 3 systemic sclerosis, 2 Sjogren’s syndrome and 1 dermatomyositis and primary biliary cirrhosis. The diagnosis of sarcoidosis preceded that of rheumatic disease in 5 patients with a mean time of 11.2 years (2-27). It was found to be concomitant in 3 cases and later in 7 patients with an average time difference of 7 years (2-19). At the time of diagnosis of sarcoidosis, 3 patients received treatment with biologic drugs (etanercept, abatacept and golimumab). Fifteen patients presented adenopathies (14 mediastinal and 1 retroperitoneal), 8 lung involvement (micronodullillar interstitial pattern in 4, pulmonary nodules in 2 and unspecified 2), 1 pleural effusion, 8 cutaneous manifestations (2 erythema nodosum, 5 cutaneous sarcoidosis and 1 scar sarcoidosis), 1 muscular pattern with muscle enzymes elevation, 2 lower limb arthritis, 1 meningitis, 1 hepatosplenomegaly, 1 panuveitis and 1 posterior uveitis. The ACE values were high in 8 cases. The histopathological diagnosis of sarcoidosis was made by lung biopsy in 6 patients, ganglionar in 5, cutaneous in 3 and muscular in 1. Ten patients received systemic glucocorticoid treatment with improvement of clinical manifestations and imaging tests. One patient who presented pulmonary involvement also received mycophenolate and another with joint involvement received methotrexate and leflunomide. Conclusion A diagnosis of sarcoidosis is often challenging. We must not forget to include it in the differential diagnosis of lung affectation of our patients with chronic inflammatory rheumatic diseases and in particular in those who receive treatment with biological drugs. Disclosure of Interests Marta Valls Roc: None declared, Meritxell Salles Lizarzaburu: None declared, Sonia Minguez Blasco: None declared, Elisabet Garcia Casares: None declared, Elena Riera Alonso: None declared, Vera Ortiz-Santamaria Speakers bureau: GSK, Roche, Pfizer, MSD, Clara Sanguesa: None declared, Alejandro Olive: None declared |
