Paraneoplastic scleroderma secondary to hairy cell leukaemia successfully treated with cladribine.

however, that sarcoid of the SI joint may be more common than previously thought. A single European study found that isolated pulmonary sarcoid was associated with HLA-B27 [10], making a true association between SpA and sarcoid possible, but this finding has not been replicated and the relatively high prevalence of the two conditions (1:1000 for AS and 0.04–64/1000 for sarcoidosis [7]) makes sporadic co-occurrence likely. In conclusion, co-existence of SpA and pulmonary sarcoid is rare, but sarcoid of the SI joint may be more common than previously thought. Treatment with TNFblockade may precipitate de novo pulmonary sarcoid and with the increasing use of these drugs for the treatment of SpA accurate diagnosis in patients who present with both sacroiliitis and sarcoid is critical. The clinician should be aware that patients with SpA of sufficient severity to warrant treatment with anti-TNF agents may not report symptoms of pulmonary sarcoid due to limitation of their activity by musculoskeletal symptoms. We would therefore recommend that all AS patients undergo thorough assessment and monitoring of respiratory function prior to and during treatment with TNFblockers.