Sarcoidosis

Case
A 27-year-old woman comes to your office with painful
erythematous papules that occurred 1 day before her visit.

She has no other complaints except joint swelling and pain that
occurred 3 days ago.

The physical examination discloses low-grade fever, symmetric

swelling of the knees, PIP (proximal interphalangeal) and MCP
(metacarpophalangeal) joints, and well demarcated, 3- to 4-cm
papules over the anterior aspect of her legs.

What would be the next step in confirming the likely diagnosis

in this patient?
 Rheumatic diseases

Dematology
Non-inflammatory Inflammatory

Infectious

Gout / pseudogout

Systemic diseases

Rheumatoid arthritis

Spondyloarthritis
 Rheumatic diseases

Dematology
Non-inflammatory Inflammatory

Septic arthritis Infectious

Post-infectious Gout / pseudogout

Systemic diseases

Rheumatoid arthritis

Spondyloarthritis
 Rheumatic diseases

Niet-inflammatory
Dematology Inflammatory

Infectious
Gout
Gout / pseudogout
Pseudogout
Systemic diseases

Rheumatoid arthritis

Spondyloarthritis
 Rheumatic diseases

Non-inflammatory
Dematology Inflammatory

Infectious

Gout / pseudogout
SLE
Systemic disease
Wegener
Rheumatoid arthritis

Spondyloarthritis
 Rheumatic diseases

Dematology
Dematology
Non-inflammatory Inflammatory

Infectious

Gout / pseudogout

Systemic disease

Rheumatoid arthritis

Spondyloarthritis
 Rheumatic diseases

Non-inflammatory
Dematology Inflammatory

Infectious

Gout / pseudo gout

Arthritis psoriatica
Systemic disease
Arthritis and IBD

Reactive arthritis Rheumatoid arthritis

Axial spondylitis Spondyloarthritis

 Definition
a systemic disease
unknown cause,
characterized histologically by
the presence of nonspecific noncaseating
granulomas in the lung and other organs

Incidence:
More in Black
20-40
 Clinical manifestation
Commonly:
Discovered in a completely asymptomatic patient

How is it discovered?
Chest X-Ray in the form of Bilateral Hilar Lymphadenopathy

Most common:
Pulmonary involvement 90%

Almost any organ

Ocular
Skin
Myocardial
Rheumatologic
Gastrointestinal
Neurologic manifestations can also occur.
 Symmetrical Arthritis:
Proximal interpharengeal (PIP)
How to differentiate

You need an X-Ray

 Acute Saroid Syndrome
Lofgren's syndrome
Heerfordt syndrome

They have better prognosis

 Diagnosis:
Definitive Biopsy
X-Ray
Liver test
Lab test

Prognosis:
80% with lung involvement:
Remain stable or
Resolves

Treatment:
No evidence
No complains:
wait and see or NSAIDs
Organs involvement:
Steroid
 Summary
Systemic
Asymptomatic Bilateral Hilar
Lymphadenopathy
Arthritis: Proximal interpharengeal (PIP)

Treatment:
Wait and see
Steroid if needed