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结节病在风湿病学方面的视角:单中心风湿病诊所经验

Perspective of sarcoidosis in terms of rheumatology: a single-center rheumatology clinic experience.

作者信息

Karabulut Yusuf, Öz Nuran, Gezer Halise Hande, Esen İrfan, Duruöz Mehmet Tuncay

机构信息

Department of Internal Medicine, Division of Rheumatology, Yıldırım Doruk Hospital, Bursa, Turkey.

Department of Physical Medicine and Rehabilitation, Division of Rheumatology, Marmara University School of Medicine, Istanbul, Turkey.

出版信息

Rheumatol Int. 2022 Dec;42(12):2191-2197. doi: 10.1007/s00296-022-05193-2. Epub 2022 Aug 25.

Abstract

Sarcoidosis may present with many rheumatological symptoms as well as mimic and/or may occur concomitantly with many other rheumatic diseases. We examined the demographic, clinical and laboratory characteristics of patients diagnosed with sarcoidosis in the rheumatology department. This study planned as retrospective cross-sectional study. Medical records of patients who applied to our rheumatology outpatient clinic due to complain of musculoskeletal problems and then diagnosed sarcoidosis were retrospectively investigated. Joint findings, extrapulmonary involvements, and coexisting rheumatic disease were evaluated. Fifty-six patients (41.21 ± 7.83 years, 75% female) were included. The duration of the disease was 49.61 ± 29.11 months, and the follow-up period was 26.66 ± 13.26 months. All patients had pulmonary system involvement. Arthralgia was present in 91.10% of 56 patients and arthritis in 89.29% of patients. Examining the subtypes of the arthritis findings, mono-arthritis was found in 31/50 (62%) patients, oligo-arthritis in 15/50 (30%) patients, and polyarthritis in 4/50 (8%) patients. A total of 11 (19.60%) patients were diagnosed with uveitis. Excision of the mediastinal LAP was performed in a total of 37 patients (66.1%) and became the most commonly employed method. Considering the treatment distribution of the patients under followed-up, it is seen that non-steroidal anti-inflammatory treatments were used in 15 (26.8%) patients, corticosteroids in a total of 40 (71.4%) patients, methotrexate in a total of 15 patients (26.8%), azathioprine in six (10.7%) patients, hydroxychloroquine in 14 (25%) patients, and infliximab in one (1.8%) patient. As sarcoidosis is a mimicking disease, a good differential diagnosis should be made to avoid misdiagnosis and in order not to be late in diagnosis and treatment. Physicians, especially rheumatologists, should remember sarcoidosis more frequently as the disease may overlap with other rheumatological diseases and may occur with many rheumatological manifestations.

摘要

结节病可能会出现许多风湿性症状,并且可能模仿和/或与许多其他风湿性疾病同时发生。我们研究了在风湿科被诊断为结节病的患者的人口统计学、临床和实验室特征。本研究计划为回顾性横断面研究。对因肌肉骨骼问题前来我们风湿科门诊就诊,随后被诊断为结节病的患者的病历进行回顾性调查。评估关节表现、肺外受累情况以及并存的风湿性疾病。纳入了56例患者(年龄41.21±7.83岁,75%为女性)。病程为49.61±29.11个月,随访期为26.66±13.26个月。所有患者均有肺部系统受累。56例患者中有91.10%出现关节痛,89.29%出现关节炎。检查关节炎表现的亚型,50例患者中有31例(62%)为单关节炎,15例(30%)为少关节炎,4例(8%)为多关节炎。共有11例(19.60%)患者被诊断为葡萄膜炎。共有37例患者(66.1%)进行了纵隔淋巴结活检切除术,这成为最常用的方法。考虑到随访患者的治疗分布情况,可见15例(26.8%)患者使用了非甾体类抗炎治疗,40例(71.4%)患者使用了皮质类固醇,15例患者(26.8%)使用了甲氨蝶呤,6例(10.7%)患者使用了硫唑嘌呤,14例(25%)患者使用了羟氯喹,1例(1.8%)患者使用了英夫利昔单抗。由于结节病是一种具有模仿性的疾病,应进行良好的鉴别诊断以避免误诊,并且为了不延误诊断和治疗。医生,尤其是风湿科医生,应更频繁地记住结节病,因为该疾病可能与其他风湿性疾病重叠,并可能出现许多风湿性表现。

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