Sarcoidosis of the musculoskeletal system

Sarcoidosis is a multisystem disease of unknown cause. It most often affects young and middle-aged people. It often presents with bilateral hilar adenopathy, pulmonary infiltrates, and eye and skin lesions. The liver, spleen, lymph nodes, salivary glands, heart, nervous system, muscles, bones and other organs can also be affected.

Epidemiology
Joint pain is present in 25-30% of patients (28% in our case).

Symptoms
Acute migrating oligo- or polyarticula arthritis may be the first symptom of sarcoidosis. Nejčastěji postihuje kotníky (100 %). It most often affects the ankles (100%). Less often, knees (41%), wrists (33%), elbows (20%), other joints are affected far less. Periarticular edema without intra-articular effusion is often present. It is usually self-limiting and usually does not recur.

Symptoms usually persist for several weeks to 3 months. It is often associated with benign hilar lymphadenopathy (BHL) and erythema nodosum in Löfgren’s syndrome.

Chronic arthritis is rare and has been found mainly in black Americans. It only appears when sarcoidosis is long-lasting and can be deforming.

Myopathy with proximal muscle weakness is rare, occurs more often in women, and may be the only manifestation of the disease. It must be differentiated from corticoids- induced myopathy. An increase in aldolase and CPK (creatine phosphokinase) with a decrease after treatment is indicative of the diagnosis. The yield of muscle biopsy from a randomly selected site is high. Evidence of muscle infiltration and granulomas in 75-100% of patients.

Bone involvement is described in 5% of patients, may be painful, but is usually asymptomatic. It is mostly associated with the chronic course of the disease and skin involvement. Cystic changes on the bones of the hand and foot are pathognomonic.

Jüngling’s disease presents as focal osteolytic lesions.

Therapy
In the case of acute sarcoidosis arthritis, nonsteroidal antirheumatic drugs are the drug of choice, in the case of chronic arthritis, administration of antimalarials (hydroxychloroquinone or chloroquine).

In the case of more severe acute or chronic arthritis, myopathy or bone involvement, administration of systemic corticosteroids or low doses of methotrexate is appropriate.

Related articles

 * Sarcoidosis
 * Sarcoidosis (pathology)
 * Sarcoidosis (internal)

Source

 * ANTON, Jan. Material for the lecture "Sarcoidosis".