SARCOIDOSIS AND THE JOINTS

Joint problems in sarcoidosis patients are common and can often result in pain and difficulty moving.

Joint Inflammation

A joint connects two bones and allows movement. There are various types of joints, for example hinge joints (elbow), saddle joints (attachment of thumb on hand), ovoid joints (wrist) and ball joints (shoulder and hip).

During movement there are sometimes large forces on joints. These are first absorbed by a layer of cartilage that lines the ends of the bones. The cartilage acts as a strap holding the joint firmly together. Synovial fluid, located in the cavity between the bones, is a viscous lubricating liquid which reduces friction between cartilage and ensures the bones smoothly glide past each other. Synovial fluid is produced in the joint membrane.

Joint problems in sarcoidosis occur when this membrane is irritated or even inflamed. Additional excess synovial fluid is produced which means the joint cannot move so easily.

There are two types of joint pain, acute and chronic.

Acute Joint Pain

Acute joint pain is the most common in sarcoidosis patients. It often occurs simultaneously with fevers and skin lesions (erythema nosodum) (see also SarcoidosisUK leaflet Sarcoidosis and the Skin). In combination with each of these symptoms it is referred to as the acute form of the disease (Löfgren Syndrome).

Symptoms:

  • sudden onset of pain, usually on the ankles

  • pain also possible in knees, wrists or elbows

  • sporadic pain to hands, feet or shoulders

  • several joints painful simultaneously or in rapid succession

  • joints become red and swollen

  • severe pain in the joints

  • rigidity in the joints

Treatment:

Acute joint pain usually heals naturally after 6 to 24 weeks. Your doctor may inject corticosteroids at the site of the inflammation. They may recommend painkillers or Non-Steroidal Anti-Inflammatory Drugs (NSAIDs). Naproxen and ibuprofen are common examples.

Chronic Joint Pain

Chronic joint pain affects less than 1% of all sarcoidosis patients. The symptoms are very similar to rheumatoid arthritis. In addition to inflammation around the joint (periarthritis) as may occur in the acute form, the tendon sheaths may become inflamed (tenosynovitis). Finally, cavities containing fluid (cysts) may form in the joints.

Symptoms:

  • chronic pain emerges gradually

  • aching in and around the joints

  • swollen, red and hot joints

  • tendon sheath inflammation, often involving the fingers

Treatment:

Your doctor may prescribe the following means to suppress the inflammation leading to chronic joint pain:

  • corticosteroid injections at the site of inflammation;

  • steroid tablets (prednisone/prednisolone);

  • antimetabolites such as methotrexate, whether or not in addition to prednisone;

  • sometimes immunosuppressive¬†drugs such as azathioprine or hydroxychloroquine;

  • if there are insufficient results, antibody biological drugs such as infliximab could be used.

Techniques to Understand your Condition

Joint pain is diagnosed via consultation with your doctor. In some cases further investigations may be warranted. These can include:

Bone scan (scintigraphy): you will receive an injection of a radioactive fluid in your arm. After 3 to 5 hours, this will spread all over the body and be absorbed by the bones. Computers can then record joint and bone movement to be assessed by your doctor.

Ultrasonography: images are created using radio waves. Joint and bone movement can then be assessed by your doctor.

MRI (Magnetic Resonance Imaging) scan: this gives information about the different types of tissues in the portion of the body being examined. With the help of a magnetic field and radio waves, relevant parts of the body are imaged.

Biopsy: your doctor will take a sample piece of tissue from the inflamed joint to be examined under the microscope. The presence of granulomas may be a confirmation of the diagnosis of sarcoidosis.

Advice

Inflamed joints can be extremely painful and can restrict daily movement. Despite this, try to keep moving and exercise daily. If you experience moderate to severe joint pain as a result of the exercise, stop immediately and consult your doctor.