Enzenauer R J, West S G
Department of Medicine, Fitzsimons Army Medical Center, Aurora, CO 80045.
Semin Arthritis Rheum. 1992 Aug;22(1):1-17. doi: 10.1016/0049-0172(92)90043-d.
Sarcoidosis is a multisystem granulomatous disease of unknown etiology. Sarcoidosis coexisting with connective tissue diseases, once considered rare, complicates various such disorders, including rheumatoid arthritis, systemic lupus erythematosus, systemic sclerosis, Sjögren's syndrome, and the spondyloarthropathies. Symptoms common to sarcoidosis and autoimmune disease include keratoconjunctivitis sicca, weight loss, fever, lymphadenopathy, pulmonary complaints, and cutaneous lesions. Consequently, the diagnosis of sarcoidosis in association with connective tissue disease is often difficult and may require biopsy of the lung, liver, skin, lymph node, muscle, or bone marrow for pathological confirmation. Abnormalities of immune function as well as autoantibody production, including rheumatoid factor and antinuclear antibodies, are seen in sarcoidosis and in connective tissue diseases, suggesting a common immunopathogenic mechanism. The severity and course of sarcoidosis associated with autoimmune disease is variable. The incidence of sarcoidosis in association with rheumatic disease may be underestimated if new symptoms of sarcoidosis are attributed to the primary rheumatic disease and a secondary diagnosis is not pursued.
结节病是一种病因不明的多系统肉芽肿性疾病。结节病与结缔组织病并存，这种情况曾被认为较为罕见，它会使多种此类疾病复杂化，包括类风湿关节炎、系统性红斑狼疮、系统性硬化症、干燥综合征以及脊柱关节病。结节病和自身免疫性疾病的共同症状包括干燥性角结膜炎、体重减轻、发热、淋巴结病、肺部症状以及皮肤病变。因此，结节病合并结缔组织病的诊断往往很困难，可能需要对肺、肝、皮肤、淋巴结、肌肉或骨髓进行活检以获得病理证实。在结节病和结缔组织病中都可见免疫功能异常以及自身抗体产生，包括类风湿因子和抗核抗体，这提示存在共同的免疫致病机制。与自身免疫性疾病相关的结节病的严重程度和病程各不相同。如果结节病的新症状被归因于原发性风湿性疾病而未进行继发性诊断，那么结节病与风湿性疾病并存的发生率可能被低估。
