Musculoskeletal sarcoidosis

Sarcoidosis is a multisystem disease of unknown cause. It most often affects young and middle-aged people. It is often manifested by bilateral hilar adenopathy, pulmonary infiltrates, and ocular 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 usually present in 25-30% of patients (28% in our country).

Symptoms
Acute migrating oligo- or polyarticular arthritis may be the first sign of sarcoidosis. It most often affects the ankles (100%). Less often the knees (41%), wrists (33%), elbows (20%), other joints are much less affected. Periarticular edema without intra-articular effusion is often present. It is usually self-limiting and usually non-recurrent.

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

Chronic arthritis is uncommon, found especially in black Americans. It occurs only after a long duration of sarcoidosis and can be deforming.

Myopathy with proximal muscle weakness is rare, more common in women, and may be the only manifestation of the disease. It must be distinguished from corticoid- induced myopathy. The diagnosis is indicated by an increase in aldolase and CPK (creatine phosphokinase) with a decrease after treatment. The yield of muscle biopsy from a randomly selected site is high. Demonstration of muscle and granuloma infiltration in 75-100% of patients.

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

Jüngling´s disease manifests as focal osteolytic lesions.

Therapy
In the case of acute sarcoid arthritis, non-steroidal anti-inflammatory drugs are the drug of choice; in the case of chronic arthritis the use of antimalarials (hydroxychloroquine or chloroquine) may be beneficial.

In case of severe acute or chronic arthritis, myopathy or bone disease, systematic corticosteroids or low doses of methotrexate should be used.



Source

 * ANTON, Jan. Materiály k přednášce "Sarkoidóza".

Reference
HUNNINGHAKE, GW, U COSTABEL and M ANDO, et al. ATS / ERS / WASOG statement on sarcoidosis. American Thoracic Society / European Respiratory Society / World Association of Sarcoidosis and other Granulomatous Disorders. Sarcoidosis Vasc Diffuse Lung Dis [online] ''. ''1999, vol 16, no. 2, pp. 149-73, also available from < https://www.ncbi.nlm.nih.gov/pubmed/10560120 >. ISSN 1124-0490.