Generic placeholder image

Current Rheumatology Reviews


ISSN (Print): 1573-3971
ISSN (Online): 1875-6360

Review Article

Musculoskeletal Manifestations of Sarcoidosis: A Review Article

Author(s): Somayeh Shariatmaghani, Roshanak Salari, Maryam Sahebari, Payman Shalchian Tabrizi and Masoumeh Salari*

Volume 15, Issue 2, 2019

Page: [83 - 89] Pages: 7

DOI: 10.2174/1573397114666180425111901

Price: $65


Background: Sarcoidosis is a multisystem inflammatory disease with an etiology that is not clearly understood. Amongst the different organs that may be affected, the lungs are the most common. Musculoskeletal manifestations of the disease are uncommon.

Objectives: They include arthropathy, bone lesions, or myopathy, all of which may occur as initial symptoms or develop during the course of the disease.

Methods: Articular involvement my present as arthralgia or arthritis. Skeletal complications usually develop in the chronic state of the disease. Muscular disease is rare and usually asymptomatic. Appropriate imaging modalities including X-ray, MRI, FDG-PET/CT assist in the diagnosis of rheumatic sarcoidosis. However, biopsy is necessary for definite diagnosis.

Result and Conclusion: In most cases of musculoskeletal involvement, NSAIDs and corticosteroids are sufficient for symptomatic management. For more resistant cases immunosuppressive drugs (i.e., methotrexate) and TNF- inhibitors are used. Our aim is to review various types of musculoskeletal involvement in sarcoidosis and their existing treatment options.

Keywords: Musculoskeletal sarcoidosis, treatment options, NSAIDs, immunosuppressive drugs, granulamotous disease, Th1.

Graphical Abstract
Fayad F, Lioté F, Berenbaum F, Orcel P, Bardin T. Muscle involvement in sarcoidosis: A retrospective and followup studies. J Rheumatol 2006; 33(1): 98-103.
Korkmaz M, Uslu S, Korkmaz H, Çetinkol Y. A rare presentation of sarcoidosis with nasal bone involvement. Allergy Rhinol (Providence) 2016; 7(1): 45-9.
Garg S, Malaviya AN, Kapoor S, Rawat R, Agarwal D, Sharma A. Acute inflammatory ankle arthritis in northern India--Löfgren’s syndrome or Poncet’s disease? J Assoc Physicians India 2011; 59: 87-90.
Aptel S, Lecocq-Teixeira S, Olivier P, Regent D, Teixeira PG, Blum A. Multimodality evaluation of musculoskeletal sarcoidosis: Imaging findings and literature review. Diagn Interv Imaging 2016; 97(1): 5-18.
Nishiwaki T, Yoneyama H, Eishi Y, et al. Indigenous pulmonary Propionibacterium acnes primes the host in the development of sarcoid-like pulmonary granulomatosis in mice. Am J Pathol 2004; 165(2): 631-9.
Fang C, Huang H, Xu Z. Immunological evidence for the role of mycobacteria in sarcoidosis. a meta-analysis. PLoS One 2016; 11(8): e0154716.
Chen ES, Moller DR. Sarcoidosis--scientific progress and clinical challenges. Nat Rev Rheumatol 2011; 7(8): 457-67.
Silva E, Souchelnytskyi S, Kasuga K, Eklund A, Grunewald J, Wheelock ÅM. Quantitative intact proteomics investigations of alveolar macrophages in sarcoidosis. Eur Respir J 2013; 41(6): 1331-9.
Grunewald J, Eklund A. Löfgren’s syndrome: Human leukocyte antigen strongly influences the disease course. Am J Respir Crit Care Med 2009; 179(4): 307-12.
Tong X, Ma Y, Niu X, et al. The BTNL2 G16071A gene polymorphism increases granulomatous disease susceptibility: A meta-analysis including FPRP test of 8710 participants. Medicine (Baltimore) 2016; 95(30): e4325.
Lockstone HE, Sanderson S, Kulakova N, et al. Gene set analysis of lung samples provides insight into pathogenesis of progressive, fibrotic pulmonary sarcoidosis. Am J Respir Crit Care Med 2010; 181(12): 1367-75.
Xie HJ, Wu M, Niu Y, Shen B, Huo Y, Cheng Y. Associations between tumor necrosis factor alpha gene polymorphism and sarcoidosis: A meta-analysis. Mol Biol Rep 2014; 41(7): 4475-80.
Zhu R, Bi LQ, Kong H, Tilley SL, Wang H, Xie WP. Meta-analytical association between angiotensin-converting enzyme gene polymorphisms and sarcoidosis risk. Genet Mol Res 2015; 14(2): 3590-600.
Yang H, Mo T, Nie W, Li B. Angiotensin converting enzyme I/D polymorphism and sarcoidosis risk. Sarcoidosis Vasc Diffuse Lung Dis 2016; 32(4): 284-8.
Wu YY, Janckila AJ, Slone SP, Perng WC, Chao TY. Tartrate-resistant acid phosphatase 5a in sarcoidosis: Further evidence for a novel macrophage biomarker in chronic inflammation. J Formos Med Assoc 2014; 113(6): 364-70.
Baughman RP, Teirstein AS, Judson MA, et al. Clinical characteristics of patients in a case control study of sarcoidosis. Am J Respir Crit Care Med 2001; 164(10 Pt 1): 1885-9.
Kobak S. Sarcoidosis: A rheumatologist’s perspective. Ther Adv Musculoskelet Dis 2015; 7(5): 196-205.
Thelier N, Allanore Y. Localisations ostéoarticulaires de la sarcoidosis. In: EMC - Appareil locomoteur. 2009; pp. 1-11. [14-027-C-10]
Salari M, Rezaieyazdi Z. Prevalence and clinical picture of musculoskeletal sarcoidosis. Iran Red Crescent Med J 2014; 16(7): e17918.
Ungprasert P, Crowson CS, Matteson EL. Clinical characteristics of sarcoid arthropathy: A population-based study. Arthritis Care Res (Hoboken) 2016; 68(5): 695-9.
Fodor L, Bota IO, Fodor M, Ciuce C. Sarcoid flexor tenosynovitis as a single early manifestation of the disease. J Plast Reconstr Aesthet Surg 2012; 65(8): e217-9.
Grunewald J, Eklund A. Sex-specific manifestations of Löfgren’s syndrome. Am J Respir Crit Care Med 2007; 175(1): 40-4.
Sato H, Grutters JC, Pantelidis P, et al. HLA-DQB1*0201: A marker for good prognosis in British and Dutch patients with sarcoidosis. Am J Respir Cell Mol Biol 2002; 27(4): 406-12.
Caso F, Costa L, Rigante D, et al. Caveats and truths in genetic, clinical, autoimmune and autoinflammatory issues in Blau syndrome and early onset sarcoidosis. Autoimmun Rev 2014; 13(12): 1220-9.
Spagnolo P, Renzoni EA, Wells AU, et al. C-C chemokine receptor 2 and sarcoidosis: Association with Lofgren’s syndrome. Am J Respir Crit Care Med 2003; 168(10): 1162-6.
Inoue Y, Kawaguchi Y, Shimojo N, et al. A case of infantile Takayasu arteritis with a p.D382E NOD2 mutation: An unusual phenotype of Blau syndrome/early-onset sarcoidosis? Mod Rheumatol 2013; 23(4): 837-9.
Haddad N. Oliveira Filho Jd, Nasser KdaR, Corbett AM, Tebet AC, Reis ML. Musculoskeletal and cutaneous sarcoidosis: Exuberant case report. An Bras Dermatol 2014; 89(4): 660-2.
Thelier N, Assous N, Job-Deslandre C, et al. Osteoarticular involvement in a series of 100 patients with sarcoidosis referred to rheumatology departments. J Rheumatol 2008; 35(8): 1622-8.
Loupasakis K, Berman J, Jaber N, et al. Refractory sarcoid arthritis in World Trade Center-exposed New York City firefighters: A case series. J Clin Rheumatol 2015; 21(1): 19-23.
Briongos-Figuero LS, Ruiz-de-Temiño Á. Pérez-Castrillón. Sarcoidosis and sacroiliitis, a case report. Rheumatol Int 2012; 32(9): 2949-50.
Malaviya AN, Sawhney S, Kapoor S, Garg S. Vertebral sarcoid mimicking ankylosing spondylitis or just a co-incidence? J Assoc Physicians India 2010; 58: 709-11.
Kobak Ş, Karaarslan AA. Yilmaz H1, Sever F.Co-occurrence of rheumatoid arthritis and sarcoidosis. BMJ Case Rep 2015; 6 2014 208803.
Saghafi M, Sahebari M, Nabavi Sh, et al. Clinical and epidemiological manifestation of 100 patients with sarcoidosis and sarcoid arthritis. Medical Journal of Mashhad University of Medical Sciences 2015; 58(2): 270-5.
Massara A, Cavazzini L, La Corte R, Trotta F. Sarcoidosis appearing during anti-tumor necrosis factor alpha therapy: A new “class effect” paradoxical phenomenon. Two case reports and literature review. Semin Arthritis Rheum 2010; 39(4): 313-9.
Conte G, Zugni F, Colleoni M, Renne G, Bellomi M, Petralia G. Sarcoidosis with bone involvement mimicking metastatic disease at (18)F-FDG PET/CT: Problem solving by diffusion whole-body MRI. Ecancermedicalscience 2015; 9: 537.
Freyschmidt J, Freyschmidt P. [Skeletal sarcoidosis]. Radiologe 2016; 56(10): 904-9.
Zhou Y, Lower EE, Li H, Farhey Y, Baughman RP. Clinical characteristics of patients with bone sarcoidosis 2017; 47(1): 143-8.
Sparks JA, McSparron JI, Shah N, et al. Osseous sarcoidosis: clinical characteristics, treatment, and outcomes--experience from a large, academic hospital. Semin Arthritis Rheum 2014; 44(3): 371-9.
Wilcox A, Bharadwaj P, Sharma OP. Bone sarcoidosis. Curr Opin Rheumatol 2000; 12(4): 321-30.
Albers BK, Sluzevich JC, Garner HW. Sarcoidosis: radiographic manifestations in the nails and distal phalanges. BMC Oral Health 2015; 15: 168.
Aranegui B, Garcia-Cruz A, de la Torre C, González-Valladares MG. Trachyonychia and sarcoidosis. J Am Acad Dermatol 2010; 63(1): 159-60.
Wiesli MG, Hostettler KE, Tamm M, Jaquiéry C. Osteolysis of unknown origin: A case report. Joint Bone Spine 2016; 83(3): 344-5.
Nair V, Prajapat D, Talwar D. Sarcoidosis and multiple myeloma: concurrent presentation of an unusual association. Skeletal Radiol 2016; 45(5): 717-21.
Baughman RP, Janovcik J, Ray M, Sweiss N, Lower EE. Calcium and vitamin D metabolism in sarcoidosis. Sarcoidosis Vasc Diffuse Lung Dis 2013; 30(2): 113-20.
Van Raalte DH, Goorden SM, Kemper EA, Brosens LA, ten Kate RW. Sarcoidosis-related hypercalcaemia due to production of parathyroid hormone-related peptide. Ecancermedicalscience 2015; 9: 537.
Kinné M, Filleron A, Salet R, Saumet L, Baron Joly S, Tran TA. [Hypercalcemia revealing sarcoidosis in a child]. Arch Pediatr 2016; 23(5): 508-13.
Bolland MJ, Wilsher ML, Grey A, et al. Bone density is normal and does not change over 2 years in sarcoidosis. Osteoporos Int 2015; 26(2): 611-6.
Nessrine A, Zahra AF, Taoufik H. Musculoskeletal involvement in sarcoidosis. J Bras Pneumol 2014; 40(2): 175-82.
Grossman JM, Gordon R, Ranganath VK, et al. American College of Rheumatology 2010 recommendations for the prevention and treatment of glucocorticoid-induced osteoporosis. Arthritis Care Res (Hoboken) 2010; 62(11): 1515-26.
Sweiss NJ, Lower EE, Korsten P, Niewold TB, Favus MJ, Baughman RP. Bone health issues in sarcoidosis. Curr Rheumatol Rep 2011; 13(3): 265-72.
Challal S, Semerano L, Nunes H, et al. Teriparatide for osteoporosis in patients with sarcoidosis: Report on risk-benefit ratio in four cases. Osteoporos Int 27(4): 1603-10.
Maeshima S, Koike H, Noda S, et al. Clinicopathological features of sarcoidosis manifesting as generalized chronic myopathy. J Neurol 2015; 262(4): 1035-45.
Nishikubo K, Hyodo M, Kawakami M, Kobayashi T. 14A rare manifestation of cricopharyngeal myopathy presenting with dysphagia in sarcoidosis. Sarcoidosis Vasc Diffuse Lung Dis 2011; 28(1): 72-4.
Motomiya M, Iwasaki N, Kawamura D. Finger flexion contracture due to muscular involvement of sarcoidosis. Hand Surg 2013; 18(1): 85-7.
Altmann S, Schreiber J, Damert HG, Mirastschijski U, Schneider W. An isolated hand tumour as primary manifestation of sarcoidosis. Mod Rheumatol 2012; 22(1): 142-6.
Sanmaneechai O, Swenson A, Gerke AK, Moore SA, Shy ME. Inclusion body myositis and sarcoid myopathy: Coincidental occurrence or associated diseases. Neuromuscul Disord 2015; 25(4): 297-300.
Ogane K, Kato T, Mizushima I, Kawano M, Yamagishi M. A case of sarcoidosis developing as sarcoid myopathy concomitant with systemic sclerosis and review of the literature. Eur Respir J 2011; 38(3): 628-34.
Larue S, Maisonobe T, Benveniste O, et al. Distal muscle involvement in granulomatous myositis can mimic inclusion body myositis. Arch Pediatr 2016; 23(5): 508-13.
Scadding JG. Prognosis of intrathoracic sarcoidosis in England. A review of 136 cases after five years’ observation. BMJ 1961; 2(5261): 1165-72.
Talmi D, Smith S, Mulligan ME. Central skeletal sarcoidosis mimicking metastatic disease. Skeletal Radiol 2008; 37(8): 757-61.
Yamada S, Nakanishi H, Hirayama M, Katsuno M, Sobue G. 67Ga scintigraphy as a therapeutic marker for spinal cord and muscular sarcoidosis: A case report. Rinsho Shinkeigaku 2015; 55(9): 665-8.
Sobic-Saranovic D, Artiko V, Obradovic V. FDG PET imaging in sarcoidosis. Semin Nucl Med 2013; 43(6): 404-11.
Mostard RL, Prompers L, Weijers RE, et al. F-18 FDG PET/CT for detecting bone and bone marrow involvement in sarcoidosis patients. Clin Nucl Med 2012; 37(1): 21-5.
Judson MA, Costabel U, Drent M, et al. The WASOG Sarcoidosis Organ Assessment Instrument: An update of a previous clinical tool. Sarcoidosis Vasc Diffuse Lung Dis 2014; 31(1): 19-27.
Han EJ, Jang YS, Lee IS, Lee JM, Kang S, Kim HS. Muscular sarcoidosis detected by F-18 FDG PET/CT in a hypercalcemic patient. J Korean Med Sci 2013; 28(9): 1399-402.
Grozdic Milojevic I, Sobic-Saranovic D, Videnovic-Ivanov J, Saranovic D, Odalovic S, Artiko V. FDG PET/CT in bone sarcoidosis. Lung India 2016; 33(1): 75-8.
Kobak S, Yalçin M, Sever F, Oncel G. Sarcoidosis presenting as Löfgren’s syndrome with myopathy. Case Rep Rheumatol 2013; 2013: 125251.
Kiltz U, Braun J. Use of methotrexate in patients with sarcoidosis. Clin Exp Rheumatol 2010; 28(5)(Suppl. 61): S183-5.
Drent M, Cremers JP, Jansen TL, Baughman RP. Practical eminence and experience-based recommendations for use of TNF-α inhibitors in sarcoidosis. Sarcoidosis Vasc Diffuse Lung Dis 2014; 31(2): 91-107.
Moller DR. Treatment of sarcoidosis - from a basic science point of view. J Intern Med 2003; 253(1): 31-40.
Hobbs K. Chronic sarcoid arthritis treated with intraarticular etanercept. Arthritis Rheum 2005; 52(3): 987-8.
Sweiss NJ, Welsch MJ, Curran JJ, Ellman MH. Tumor necrosis factor inhibition as a novel treatment for refractory sarcoidosis. Arthritis Rheum 2005; 53(5): 788-91.

Rights & Permissions Print Cite
© 2024 Bentham Science Publishers | Privacy Policy