Diagnosis of acute sarcoid arthritis (Löfgren's syndrome) in India, a country with high burden of tuberculosis

Abstract

ObjectiveThe present study was carried out to test if Visser et al's 2002 diagnostic criteria for acute sarcoid arthritis (Löfgren syndrome) are applicable in India, a country with high burden of tuberculosis. Methods30 consecutive patients classified as acute sarcoid arthritis according to Visser et al's criteria were included. They were screened for TB with standard Mantoux test, radiograph of chest and if found normal, contrast enhanced computerized tomography (CE-CT) of thorax. Results24 of 30 patients showed a negative Mantoux test as well as normal chest radiograph and CE-CT. These patients were labeled as acute sarcoid arthritis. There were, 6 (20%) patients who had one or more features of TB by way of a positive Mantoux test and/or mediastinal lymphadenopathy with central necrosis, or asymmetrical hilar lymphadenopathy. The latter patients were diagnosed as having Poncet's disease, a parainfectious arthritis associated with the presence of tuberculosis at a distant site way from musculoskeletal system. Therapeutic response to low-dose glucocorticoid, hydroxychloroquine and low-dose methotrexate produced dramatic results among those diagnosed with acute sarcoid arthritis. On the other hand, those diagnosed as having Poncet's disease were given standard anti-TB drugs with excellent response. ConclusionIn a country with high burden of TB like India Visser et al's clinical criteria for the diagnosis of acute sarcoid arthritis (Löfgren syndrome) may not be very specific; TB must be ruled out before diagnosing acute sarcoid arthritis (Löfgren syndrome).