en Reumatology Reumatology case report case report <span style="font-size:14px;"><span style="font-family:times new roman;"><span style="color:#0000FF;"><strong><em>Background:</em></strong></span> Sarcoidosis is a multisystem granulomatous disease. Co-existence with spondyloarthritis (SA) has been more described as an adverse effect of anti-TNF &alpha; therapy than an association. We report herein a case of a typical sarcoidosis confirmed by histological proofs and an advanced SA with a bamboo column.<br> <span style="color:#0000FF;"><strong><em>Case Presentation:</em></strong></span> A 48-years-old woman presented with inflammatory back pain for 5 years and ankle swelling for 1 year. On physical examination, she had an exaggerated dorsal kyphosis and disappearance of lumbar lordosis with limitation in motion of the cervical and lumbar spine. Laboratory tests did not show an inflammatory syndrome or hypercalcemia. Plain radiographies of the spine and pelvic revealed a triple ray appearance with sacroiliitis grade 4. Chest radiography and CT confirmed the presence of bilateral hilar lymph nodes and parenchymal nodes. Bronchoscopy and biopsies were performed showing non-calcified granulomatous reaction without cell necrosis. The diagnosis of SA was performed based on 9 points of Amor criteria associated with pulmonary sarcoidosis. She was treated with 15 mg per week of methotrexate and 1mg/kg/day of prednisone for pulmonary disease with good outcomes.<br> <span style="color:#0000FF;"><strong><em>Conclusions:</em> </strong></span>Sarcoidosis may be associated to SA besides paradoxical drug effect. The same physio pathological pathways mediate by TNF &alpha; are arguments for association than hazardous coincidence</span></span><p></p> Sarcoidosis, Ankylosing Spondylarthritis, Tumor Necrosis Factor Alpha 100 103 http://caspjim.com/browse.php?a_code=A-10-613-2&slc_lang=en&sid=1 Wafa Hamdi wafah@yahoo.com 100319475328460011214 100319475328460011214 No Department of Rheumatology, Kassab Institute of Orthopedics, Manouba, Tunisia Saoussen Miladi saoussenmld@hotmail.com 100319475328460011215 100319475328460011215 Yes Department of Rheumatology, Kassab Institute of Orthopedics, Manouba, Tunisia Dhia Kaffel Dhkaffel@yahoo.com 100319475328460011216 100319475328460011216 No Department of Rheumatology, Kassab Institute of Orthopedics, Manouba, Tunisia Imen Zouch zouci@yahoo.fr 100319475328460011217 100319475328460011217 No Department of Rheumatology, Kassab Institute of Orthopedics, Manouba, Tunisia Med Montacer Kchir kchirm@yahooo.fr 100319475328460011218 100319475328460011218 No Department of Rheumatology, Kassab Institute of Orthopedics, Manouba, Tunisia