The joint disease of sarcoidosis.

Although the first description of sarcoidosis by Jonathan Hutchinson (1877) was of a patient who "suffered from gout", only recently has it been appreciated that joint manifestations are an important part of sarcoidosis. Myers, Gottlieb, Mattman, Eckley, and Chason (1952) first described migratory polyarthritis as a presenting feature of sarcoidosis in four cases, and Gendel, Young, and Greiner (1952) reported a high incidence of joint symptoms in sarcoidosis in six of 24 patients. Subsequently the arthritis occurring in sarcoidosis has been studied by others, but these reports all concern patients selected because of their joint disease. Sokoloff and Bunim (1959) investigated five cases of sarcoidosis with arthritis, and found granulomata in the synovium of affected joints in three of the five. Williams (1961) described seven patients presenting with arthritis, in whom systemic manifestations and erythema nodosum were common, and Bianchi and Keech (1964) discussed the features of twelve cases of sarcoidosis presenting in a rheumatology clinic. The increased prevalence of a rheumatoid factor in patients with sarcoidosis was reported by Kunkel, Simon, and Fudenberg (1958), and the possibility that rheumatoid factor may play a role in the pathogenesis of pulmonary fibrosis in sarcoidosis was considered by Israel, Patterson, and Smukler (1964). Rheumatoid factor has on occasion been found in patients with sarcoidosis and joint disease (Kaplan, 1963a) but the frequency of its presence in unselected patients, with or without arthritis, is not known. Hyperuricaemia in sarcoidosis was noted in six of 25 patients by Kaplan and Klatskin (1960) and they described the co-existence and possible association of psoriasis, sarcoidosis, and gout in three.