Sarcoidosis presenting with polyarthritis.

Polyarthritis is a frequent presenting symptom in patients with sarcoidosis (Scadding, 1956; James, 1956). It is especially common in association with erythema nodosum; the combination of polyarthritis, erythema nodosum, and bilateral hilar adenopathy forming one of the distinctive syndromes of this disease (LUfgren, 1953; James, Thomson, and Willcox, 1956). Thus, Lofgren, in his series of 212 cases of bilateral hilar adenopathy believed to be due to sarcoidosis, found 1 3 cases with erythema nodosum, of whom 101 (89 per cent.) had articular symptoms. Of those without erythema nodosum, eighteen (18 per cent.) had articular symptoms (Lofgren, 1953). Similarly, James (1959) found associated polyarthralgia in 64 per cent. of a series of 62 cases of histologically proven sarcoidosis presenting with erythema nodosum. Despite the marked frequency of polyarthritis in these and other large series, little attention has been given to the pattern or duration of the joint involvement apart from mention of its similarity to acute rheumatism (James, 1958). The striking systemic upset accompanying the polyarthritis has also received little stress. Lofgren (1953) stated that the articular symptoms are mild in type, generally subsiding within a couple of weeks with reversion to normal of the sedimentation rate; apart from fever at the onset he did not mention systemic symptoms. This report concerns seven patients seen within a period of 18 months in a general medical unit in all of whom polyarthritis was the presenting symptom. Typical skin changes of erythema nodosum developed subsequently in five cases. The diagnosis of sarcoidosis was confirmed in six cares by the Kveim Test. Clinical Findings Age and Sex.-As shown in Table I (opposite), the seven patients consisted of six women and one man, their ages ranging from 28 to 57 years. Six of the patients lived in the country. None of the females had had recent pregnancies. James (1958), working in London, noted that sarcoidosis presenting with erythema nodosum was especially common in women, and mentioned its development coinciding with lactation.