Take a listen to this medical mystery and learn about a not-so-rare condition — depending on where you live. Hear some interesting historical stories about the physicians who helped establish the diagnosis, as well as an interview with a renowned expert.

• Intro :11
• A 57-year-old woman presents with multiple-week history of joint pain. She also complains of lesions on her forearms. :32
  • Initial lab results 1:30
  • She arrives at my office 1:50
  • Review of her vitals 1:57
  • Physical exam findings and patient history 2:05
  • What about the nodules on her skin? 3:20
  • Tests leading to diagnosis 4:40
  • What’s the diagnosis? 4:55
• A personal anecdote 5:20
• Symmetrical polyarticular inflammatory arthritis in the setting of erythema nodosum 6:18
• What do we know about Löfgren Syndrome? 7:45
• History of this diagnosis 8:35
• What we know 100 years later 11:13
• Focus on the inflammatory arthritis of Löfgren Syndrome 14:25
• Are these different diseases? 18:07
• Summary of what we’ve discussed so far 19:13
• Unsung heroes who showed sarcoidosis is associated with inflammatory arthritis 20:40
• Introduction of Dr. Daniel Culver 28:26
• An update on sarcoidosis with Dr. Culver 29:17
  • Why should we care about staging on X-ray? 29:22
  • Are there any clues that it may be sarcoid based on histology and morphology of the granuloma itself? 30:56
  • How does bronchoalveolar lavage help? 32:58
  • How often do you see remissions in non-Löfgren’s sarcoidosis? 34:41
  • What are your thoughts on the serum biomarkers? 36:34
  • Can you comment with your thoughts on the link between the environment and the disease? 38:25
  • What about infectious triggers? 40:06
  • Do you think genetic studies will eventually be used for diagnosis or prognosis? 41:18
  • Where do you think we’ll be with the diagnosis and treatment of sarcoidosis in 10 years? 42:38
• Thank you, Dr. Dan Culver 44:28
• Episode recap 44:40
• Follow us on Twitter @HRheuminations and leave us a review in iTunes 45:18

Daniel Culver, DO, is director of the Interstitial Lung Disease Program at Cleveland Clinic and director of The Sarcoidosis Center of Excellence at Cleveland Clinic.

We’d love to hear from you! Send your comments/questions to [email protected]. Follow us on Twitter @AdamJBrownMD @HealioRheum @HRheuminations

References:

Grunewald J, Eklund A. Am J Respir Crit Care Med. 2009;179:307-312.

Le Bras E, et al. Arthritis Care Res (Hoboken). 2014;66:318-322.

Lofgren S, Lundback H. Acta medica Scandinavica. 1952;142.

Maña J, et al. Am J Med. 1999;107:240-245.

Palmer DG, Schumacher HR. Ann Rheum Dis. 1984;43:778–782.

Segura BT, et al. Medicina Clinica (Barc). 2014;143:166-9.