Musculoskeletal involvement in sarcoidosis

Abstract

Sarcoidosis is a multisystem inflammatory disorder of unknown cause. It most commonly affects the pulmonary system but can also affect the musculoskeletal system, albeit less frequently. In patients with sarcoidosis, rheumatic involvement is polymorphic. It can be the presenting symptom of the disease or can appear during its progression. Articular involvement is dominated by nonspecific arthralgia, polyarthritis, and Löfgren's syndrome, which is defined as the presence of lung adenopathy, arthralgia (or arthritis), and erythema nodosum. Skeletal manifestations, especially dactylitis, appear mainly as complications of chronic, multiorgan sarcoidosis. Muscle involvement in sarcoidosis is rare and usually asymptomatic. The diagnosis of rheumatic sarcoidosis is based on X-ray findings and magnetic resonance imaging findings, although the definitive diagnosis is made by anatomopathological study of biopsy samples. Musculoskeletal involvement in sarcoidosis is generally relieved with nonsteroidal anti-inflammatory drugs or corticosteroids. In corticosteroid-resistant or -dependent forms of the disease, immunosuppressive therapy, such as treatment with methotrexate or anti-TNF-α, is employed. The aim of this review was to present an overview of the various types of osteoarticular and muscle involvement in sarcoidosis, focusing on their diagnosis and management.

Figure 1. Pattern of bone involvement found on X-rays in a patient with sarcoidosis: multiple, large cysts (type I). From the collection of Professor Yannick Allanore, of the Department of Rheumatology A, Descartes University, Medical School, Cochin Hospital, Paris, France. Used with the permission of Professor Allanore.

Figure 2. X-ray of hands showing cysts and acro-osteolysis (type II). From the collection of Professor Yannick Allanore, of the Department of Rheumatology A, Descartes University, Medical School, Cochin Hospital, Paris, France. Used with the permission of Professor Allanore.

Figura 1. Padrão de acometimento ósseo encontrado em radiografias de paciente com sarcoidose: múltiplos cistos grandes (tipo I). Da coleção do Professor Yannick Allanore, do Departamento de Reumatologia A, Universidade Descartes, Faculdade de Medicina, Hospital Cochin, Paris, França. Usadas com permissão do Professor Allanore.

Figura 2. Radiografias de mão evidenciando cistos e acro-osteólise (tipo II). Da coleção do Professor Yannick Allanore, do Departamento de Reumatologia A, Universidade Descartes, Faculdade de Medicina, Hospital Cochin, Paris, França. Usadas com permissão do Professor Allanore.