Wafa Hamdi, Saoussen Miladi, Dhia Kaffel, Imen Zouch, Montacer Kchir Mohamed
Department of Rheumatology, Kassab Institute of Orthopedics, Manouba. Tunisia.
Caspian J Intern Med. 2018 Winter;9(1):100-103. doi: 10.22088/cjim.9.1.100.
Sarcoidosis is a multisystem granulomatous disease. Co-existence with spondyloarthritis (SA) has been more described as an adverse effect of anti-TNF α therapy than an association. We report herein a case of a typical sarcoidosis confirmed by histological proofs and an advanced SA with a bamboo column.
A 48-years-old woman presented with inflammatory back pain for 5 years and ankle swelling for 1 year. On physical examination, she had an exaggerated dorsal kyphosis and disappearance of lumbar lordosis with limitation in motion of the cervical and lumbar spine. Laboratory tests did not show an inflammatory syndrome or hypercalcemia. Plain radiographies of the spine and pelvic revealed a triple ray appearance with sacroiliitis grade 4. Chest radiography and CT confirmed the presence of bilateral hilar lymph nodes and parenchymal nodes. Bronchoscopy and biopsies were performed showing non-calcified granulomatous reaction without cell necrosis. The diagnosis of SA was performed based on 9 points of Amor criteria associated with pulmonary sarcoidosis. She was treated with 15 mg per week of methotrexate and 1mg/kg/day of prednisone for pulmonary disease with good outcomes.
Sarcoidosis may be associated to SA besides paradoxical drug effect. The same physio pathological pathways mediate by TNF α are arguments for association than hazardous coincidence.
结节病是一种多系统肉芽肿性疾病。与脊柱关节炎（SA）并存更多地被描述为抗TNFα治疗的不良反应而非一种关联。我们在此报告一例经组织学证实的典型结节病病例以及一例伴有竹节样脊柱的晚期SA病例。
一名48岁女性，有5年炎性背痛病史，1年踝关节肿胀病史。体格检查时，她有明显的胸椎后凸畸形，腰椎前凸消失，颈椎和腰椎活动受限。实验室检查未显示炎症综合征或高钙血症。脊柱和骨盆的X线平片显示有4级骶髂关节炎的三线征。胸部X线和CT证实存在双侧肺门淋巴结和实质结节。进行了支气管镜检查和活检，显示非钙化性肉芽肿反应，无细胞坏死。基于与肺结节病相关的9分Amor标准诊断为SA。她接受了每周15毫克甲氨蝶呤和每日1毫克/千克泼尼松治疗肺部疾病，效果良好。
除了矛盾性药物效应外，结节病可能与SA有关。由TNFα介导的相同生理病理途径支持两者相关而非有害巧合。
