Acute inflammatory ankle arthritis in northern India--Löfgren's syndrome or Poncet's disease?

OBJECTIVES: To analyse patients presenting with acute inflammatory ankle arthritis from an aetiological standpoint; whether they had Löfgren's syndrome (acute presentation of sarcoidosis), or Poncet's disease (reactive arthritis due to tuberculosis infection). An additional objective was to establish a simple, practical yet optimal algorithm for diagnostic approach and management of such patients.

METHODS: The study included 18 patients from northern India presenting with isolated acute inflammatory ankle arthritis. A combination of complete clinical evaluation, Mantoux test and contrast-enhanced computerised tomography (CE-CT) of the chest was carried out and results analysed.

RESULTS: Among 18 patients presenting as inflammatory ankle arthritis is was possible to classify 10 of them as Löfgren's syndrome all of whom had negative Mantoux test and bilateral hilar lymphadenopathy without central necrosis. The other 8 patients could be classified as Poncet's disease as all of them had positive Mantoux test and showed mediastinal lymphadenopathy with or without unilateral hilar lymph nodes, with central necrosis. Finally, appropriate drug treatment (glucocorticoids with glucocorticoid-sparing drugs methotrexate and hydroxychloroquine in patients with Löfgren's syndrome; standard anti-tuberculosis drugs in Poncet's disease) gave excellent clinical response and patients remained well over a period of 1 year of follow-up.

CONCLUSION: Investigated on standard lines without any invasive procedure, patients with isolated inflammatory ankle arthritis could be classified in 2 distinct categories namely: (1) Löfgren's syndrome in its complete (with EN) or incomplete (without EN) form; (2) Poncet's disease. Appropriate treatment gave satisfactory response and patients remained well over a period of 1 year of follow-up.