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ORIGINAL ARTICLE
Year : 2014  |  Volume : 9  |  Issue : 3  |  Page : 112-114

Diagnosis of acute sarcoid arthritis (Lo€fgren's syndrome) in India, a country with high burden of tuberculosis


1 Max Super Specialty Hospital, Patparganj, India
2 Department of Rheumatology, ISIC Superspeciality Hospital, Vasant Kunj, New Delhi; A&R Clinic, Flat 2015, Sector B-2, Vasant Kunj, New Delhi, 110070

Correspondence Address:
Anand N Malaviya
Department of Rheumatology, ISIC Superspeciality Hospital, Vasant Kunj, New Delhi; A&R Clinic, Flat 2015, Sector B-2, Vasant Kunj, New Delhi, 110070

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Source of Support: None, Conflict of Interest: None


DOI: 10.1016/j.injr.2014.05.005

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Objective: The present study was carried out to test if Visser et al's 2002 diagnostic criteria for acute sarcoid arthritis (Lo€fgren syndrome) are applicable in India, a country with high burden of tuberculosis. Methods: 30 consecutive patients classified as acute sarcoid arthritis according to Visser et al's criteria were included. They were screened for TB with standard Mantoux test, radiograph of chest and if found normal, contrast enhanced computerized tomography (CE-CT) of thorax. Results: 24 of 30 patients showed a negative Mantoux test as well as normal chest radio- graph and CE-CT. These patients were labeled as acute sarcoid arthritis. There were, 6 (20%) patients who had one or more features of TB by way of a positive Mantoux test and/or mediastinal lymphadenopathy with central necrosis, or asymmetrical hilar lymphade- nopathy. The latter patients were diagnosed as having Poncet's disease, a parainfectious arthritis associated with the presence of tuberculosis at a distant site way from muscu- loskeletal system. Therapeutic response to low-dose glucocorticoid, hydroxychloroquine and low-dose methotrexate produced dramatic results among those diagnosed with acute sarcoid arthritis. On the other hand, those diagnosed as having Poncet's disease were given standard anti-TB drugs with excellent response. Conclusion: In a country with high burden of TB like India Visser et al's clinical criteria for the diagnosis of acute sarcoid arthritis (Lo€fgren syndrome) may not be very specific; TB must be ruled out before diagnosing acute sarcoid arthritis (Lo€fgren syndrome).


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