An NSAID such as naproxen is appropriate for this patient who has Löfgren syndrome, a self-limiting form of sarcoidosis characterized by a triad of acute arthritis in combination with bilateral hilar lymphadenopathy and erythema nodosum. The “arthritis” associated with Löfgren syndrome is actually a nondestructive periarthritis of the soft tissue, entheses, and tenosynovium around the joints. Symmetric involvement of the ankles is classic, but knees, wrists, and elbows can also be involved. Ninety percent of patients remit within 12 months. When the triad of features occurs, it has a 95% specificity for diagnosis, and further diagnostic tests (such as radiography or serologic testing) are unnecessary. This patient presents with the classic triad of hilar lymphadenopathy, erythema nodosum, and acute arthritis involving the ankles and therefore has Löfgren syndrome. Erythema nodosum may occur in association with a wide array of causes, including infections, medications, and systemic disease, or it may be idiopathic. Sarcoidosis and inflammatory bowel disease are the most frequently associated systemic diseases. The lesions of erythema nodosum are tender, subcutaneous nodules presenting as barely appreciable convexities on the skin surface, with a reddish hue in the acute phase. As the lesions resolve, a dull brown circular patch is often left behind. Erythema nodosum is frequently bilateral and symmetric, and it usually occurs on the distal lower extremities. Löfgren is more common among Europeans. Initial treatment is generally with NSAIDs (such as naproxen), colchicine, or low-dose prednisone.

Methotrexate, high-dose prednisone, or a tumor necrosis factor α inhibitor such as adalimumab are reserved for patients with chronic, organ-damaging forms of sarcoidosis.