One Patient, Two Distinct Diseases: Sarcoidosis and Gouty Arthritis
Sarcoidosis is a rare inflammatory disease characterized by the formation of granulomas in organs of the body. Granulomas correspond to a localized collection of inflammatory cells at sites of tissue infection. The cause of sarcoidosis remains unknown, though it usually affects the lungs and skin.
Gouty arthritis is triggered by uric acid crystal deposits in the lining of the joint and in fluid within the joints. White blood cells engulf the crystals of uric acid and release chemicals that promote inflammation, causing a painful arthritis attack accompanied by heat and redness.
Both diseases have similar clinical manifestations, such as tender red bumps on the skin and excess uric acid in the blood (hyperuricemia), so an exact diagnosis is key for proper treatment.
In the study, researchers reported the case of a 45-year-old male diagnosed with sarcoidosis who complained of pain and swelling of both ankle joints. He also had swelling, redness and recurrent tenderness of the left first metatarsophalangeal (MTP) joint — medical jargon for the left big toe joint. Importantly, 10 to 25 percent of sarcoidosis cases involve the joints.
Additionally, lab tests showed that acute phase chemicals levels were high. X-ray examination revealed nothing indicating disease in the ankle and toes, except for soft-tissue swelling. Chest radiography and thorax-computed tomography scans showed bilateral enlargement of lymph nodes of the pulmonary hila, which is indicative of sarcoidosis.
As a result, the patient was diagnosed with both gouty arthritis and sarcoidosis according to clinical, laboratory and radiologic evaluations. He was given low-dose corticosteroids (prednisolone 4 mg/day) and colchicine, indicated for the treatment of gout and arthritis.
One month later, the patient’s complaints and laboratory findings regressed. Six months later, radiological regression was observed on a control torax scan.
“In conclusion, we report herein a case with sarcoidosis coexist with gouty arthritis. Both diseases may have similar clinical manifestations and exact diagnosis is important for prognosis and treatment,” researchers wrote, adding that further studies are needed to determine whether these diseases indeed coexist or have a common trigger or origin.