Musculoskeletal Manifestations of Sarcoidosis

Abstract

Since its initial description in the late 19th century, sarcoidosis has been extensively studied. Although the general mechanism of immune activation is known, many details especially in the context of disease associations are still missing. One of such associations is the musculoskeletal complications that are widely variable in terms of presentation and response to treatment. Sarcoidosis can involve the joints leading to acute and, less commonly chronic, arthritis. While acute arthritis is mostly self-resolving in nature, chronic arthritis may lead to deformity and destruction of the joint. Sarcoidosis can also involve the muscles, leading to different pathologies primarily categorized according to the clinical presentation, despite the efforts to find a new classification based on imaging, histological, and clinical findings. The bones can be directly and indirectly affected. Different types of bone lesions have been described, although around half of these patients remain asymptomatic. Osteoporosis, increased risk of fractures, hypercalcemia, and hypercalciuria are examples of the indirect effect of sarcoidosis on the bones, possibly contributed to elevated levels of calcitriol. Nevertheless, sarcoidosis can be associated with small-vessel, medium-vessel, and large vessel vasculitis, although it is frequently difficult to differentiate between the co-existence of a pure vasculitis and sarcoidosis and sarcoid vasculitis.

Keywords: Sarcoidosis; bones; joints; muscles; pathology; treatment; vessels.

Figure 1.

A 45-year-old man with Löfgren syndrome (acute erythema nodosum, arthropathy, and bilateral hilar lymphadenopathy).

Figure 2.

Radiograph of the bilateral hands in a 32-year-old man with mild pulmonary sarcoidosis.

Figure 3.

Certain factors that could be contributing to the formation of bone lesions in patients with sarcoidosis. ^-

Figure 4.

Granulomas are surrounded by lymphocytes and plasma cells; irregular areas of necrosis are seen admixed with granulomas, but necrosis seems to be unassociated with granulomas.