A review of the musculoskeletal manifestations of sarcoidosis

Abstract

Sarcoidosis is a systemic disease of unknown aetiology that is characterized by granulomatous inflammation that can develop in almost any organ system. Musculoskeletal manifestations are seen in up to one-third of patients, ranging from arthralgia through to widespread destructive bone lesions. Inflammatory tendon lesions and periarticular swelling are more common than true joint synovitis. Despite advances in our understanding of the pathophysiology of the disease, diagnosis remains challenging. Definitive diagnosis, irrespective of organ site involvement, hinges on histological confirmation of non-caseating granuloma combined with an appropriate clinical syndrome. Musculoskeletal involvement usually develops early in the disease course. Imaging modalities, particularly fluorodeoxyglucose PET, are helpful in delineating the extent of involvement and measuring disease activity. Bone involvement may only become apparent following isotope imaging. Corticosteroids remain the cornerstone of treatment. MTX is the steroid-sparing agent of choice unless there is renal involvement. Biologic therapies are sometimes used in severe disease, although the evidence base for efficacy is inconsistent.

The Burden of Sarcoidosis Symptoms from a Patient Perspective

“…Organ-specific symptoms were comparable between the three countries, except for musculoskeletal symptoms (being most prevalent in Denmark). Musculoskeletal manifestations occur in approximately one-third of sarcoidosis patients [ 24 ]. Since they are often subclinical or not recognized because of mild or non-specific symptoms, however, their exact prevalence is unknown.…”

“…Since they are often subclinical or not recognized because of mild or non-specific symptoms, however, their exact prevalence is unknown. The most frequent musculoskeletal manifestation of sarcoidosis is an acute arthritis that occurs as part of the Löfgren syndrome [ 24 ]. Higher rates of musculoskeletal involvement have been reported since the introduction of the PET-CT [ 25 ].…”

Osseous sarcoidosis: A multicenter retrospective case-control study of 48 patients

“…Musculoskeletal manifestations of sarcoidosis are less common, observed in 25-33% of patients (4). Osseous sarcoidosis is a rare manifestation, reported in 3-13% of sarcoidosis patients (1,5,6).…”

Extrapulmonary Sarcoidosis: A Diagnostic Challenge

“…Imaging shows three distinct types of changes caused by Sarcoidosis: lytic, permeative and destructive. These result in bone resorption and cyst formation, tunneled reticular appearance of cortex and severe bone damage and fractures respectively [5].…”