Joint involvement in Lö fgren's syndrome

Objective: to study the clinical, laboratory, and instrumental features of joint involvement in patients with Löfgren's syndrome.

Patients and methods. Examinations were made in 125 patients, among whom there were 21 men and 104 women (male:female ratio, 1:5); mean age, 42±12 years (from 18 to 69 years), the referral diagnoses were erythema nodosum (EN), panniculitis or vasculitis.

Results. All the patients complained of painful red indurations on the upper and lower extremities; there were also complaints of joint pain (83%), cough, weakness, hyperhidrosis, dyspnea, myalgia, and sore throat (55%), and subfebrile temperatures (50%). Arthralgias were noted in all the cases; 70% had arthritis that was observed manly in the ankle joints (62%). In all the patients, joint damage was concurrent with EN. Articular manifestations preceded EN in 35 (28%) patients. Laboratory tests showed that the median erythrocyte sedimentation rate was 20 [14; 31] mm/hr and C-reactive protein (CRP) was 10 [6; 21] mg/l. Elevated CRP levels were significantly more common in arthritis (p = 0.003) and nodular fusion (p=0.04) and directly related to the number of subcutaneous nodules (p=0.008; r=0.29). Chest computed tomography revealed intrathoracic lymphadenopathy in all the patients; ground glass lung tissue injury (Stage II) was identified in 42% of cases. Joint damage did not depend on the X-ray stage of sarcoidosis. 54% of the patients took nonsteroidal anti-inflammatory drugs, 60% received hydroxychloroquine 600 mg/day, and 50% had glucocorticoids (GC) 4–6 mg/day. 35% of the patients received combined therapy with GC and cyclophosphamide 200 mg/week or methotrexate 15 mg/week. Articular syndrome virtually completely regressed during a year. Arthralgias in the ankle persisted in a few (4%) cases.

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