Author(s): Christopher Banse [*] aff1 , Vincent Goëb aff2
anti-TNF; articular; joint; sarcoidosis
We thank the authors for their excellent review on the different anti-TNF therapies used in the treatment of sarcoidosis [1 ]. Unfortunately, the authors did not talk about some painful events: muscular and articular involvement of sarcoidosis.
The prevalence of joint manifestations occurring during sarcoidosis is estimated at about 15 to 25% [2 ]. The articular manifestations of sarcoidosis may however be asymptomatic and therefore undiagnosed. These joint damages are often associated with an invasion of soft tissues (infiltration of the skin, lupus pernio) and generally occur whereas sarcoidosis has already been diagnosed. Visser et al . found that there was involvement of the large joints in 95% of their patients, mainly in the lower limbs (96%) and in a symmetric way (76%) [ 2 ]. It is notably well known that bi-arthritis of the ankle should suggest the diagnosis of arthritis sarcoidosis (sensitivity 95%, specificity 90%) [ 2 ]. During the articular manifestations of sarcoidosis, NSAIDs should be prescribed as the first line of therapy, especially to amend arthralgia. [ 3 ]. However, NSAIDs and painkillers are not always enough, and then corticosteroids and/or synthetic disease-modifying antirheumatic drugs (DMARDs) such as methotrexate may be considered.
Biologics, and especially anti-TNF drugs, could be prescribed during rheumatic diseases such as rheumatoid arthritis and spondyloarthritis. In cases of sarcoidosis resistant to all the...