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- Clinical Manifestations:
    - may have fevers, rash, & iritis, which can resemble symptoms of JRA.
    - pulmonary dz, erythema nodosum, abdominal pain, liver enlargement, and perihilar adenopathy may also be present.
    - labs: elevated ACE serum level is considered to be the activity marker of the disease
    - hand:
         - phalanges of the hand may contain large sacroid accumulation which may enlarge and deform the bone but do not
                  invade the soft tissue;
         - most often involves distal and middle phalanx;
         - pinched out osteolytic areas represent a concentration of granulation tissue which replace bone;
         - coarse trabecular - lace like - presentation is also common;
         - periosteal bone formation is generally not present;
         - may cause extensor tendon synovitis or may involve the flexor tendon sheath;
    - children:
         - synovium will be nontender & boggy & does not limit ROM;

- Radiographic Studies:
     - Ossification of Soft Tissue and Periosteum:
            - perarticular metastatic calcification also occurs in disorders in which hypercalcemia  predominates (eg.
                      milk alkali syndrome, sarcoidosis, and Vit D intoxication)
            - ref: Images in Clinical Medicine. Sarcoid Arthropathy


Sarcoidosis of the Hand and Wrist: a report of two cases.    

Primary musculoskeletal sarcoidosis.

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