Sarcoidosis-associated acro-osteolysis

Iranian Red Crescent Medical Journal, 2014

Background: Sarcoidosis is a multisystem disease affecting different organs with different frequency rates depending on geographical location. Musculoskeletal abnormalities includes osseous lesions (small and large bone sarcoidosis), sarcoidal arthropathy, and sarcoidal myopathy. Musculoskeletal involvement is reported in a significant number of patients. Objectives: This study aimed to determine the prevalence and clinical picture of musculoskeletal sarcoidosis in Iranian cohort of patients with sarcoidosis. Patients and Methods: We designed a descriptive cross-sectional study including 30 patients with sarcoidosis who had hospitalized in the Rheumatology Department at Ghaem Hospital, Mashhad, Iran. The patients were evaluated for musculoskeletal symptoms using history, physical examination, and paraclinical data. Results: Of the 30 studied patients, 24 were female (80%) and six were male (20%). The mean age at diagnosis was 38 years. Sarcoidal arthropathy (arthritis and periarthritis) was observed in 26 patients (86.6%). Furthermore, the initial presentation was associated with joint symptoms in 19 cases (63.3%); acute arthritis developed in 17 (65%) while bone and muscle involvements each occurred in 2 (6.6%). Conclusions: Sarcoidosis is a common disease in women aged 20 to 40 years. The most common involved joint were consecutively ankles, knees, and wrists, reaching a accumulated frequency of 86.6%; however, bone and muscle involvements were uncommon.

Seminars in Arthritis and Rheumatism, 2014

Objective: Osseous sarcoidosis has been infrequently reported. We aimed to characterize the distribution of lesions, clinical presentation, treatment, and outcomes for osseous sarcoidosis. Methods: Cases of osseous sarcoidosis were identified by directed inquiry to clinicians and electronic query. Cases were defined as having pathologic evidence of non-caseating granulomas on bone biopsy or evidence of osseous lesions on imaging attributable to sarcoidosis in patients with known sarcoidosis. Detailed characteristics were obtained by medical record review. Results: We identified a total of 20 cases of osseous sarcoidosis. Osseous lesions were detected by imaging during the initial sarcoidosis presentation in 60% of cases. In those who had a prior diagnosis of sarcoidosis, the median duration of sarcoidosis before detection of osseous involvement was 4.3 years. Symptoms were present in 50% of cases. All cases had more than one bone involved. The axial skeleton was involved in the majority of cases (90%), primarily the pelvis and the lumbar spine. Most cases required no treatment (55%); a minority of cases (45%) were treated, most often with prednisone, methotrexate, or hydroxychloroquine. Two cases required multiple immunosuppressants, including tumor necrosis factor inhibitors, for refractory symptomatic osseous sarcoidosis. Treated cases were younger than those who were untreated. At last follow-up, most cases (85%) were asymptomatic from osseous lesions. Conclusions: In this case series of osseous sarcoidosis from a single center, most patients had multiple bones affected and had other systemic manifestations of sarcoidosis. A minority required treatment for relief of symptoms, and most cases were asymptomatic at last follow-up.

Medicine Science | International Medical Journal, 2016

Sarcoidosis is an inflammatory disease which is characterized by chronic, systemic noncaseating granuloma formation. This disease generally affects the respiratory system. Bone lesions in sarcoidosis are developed in the cases with 3-13 percentage that generally asymptomatic. In this study we presented a patient of sarcoidosis that had been pulmoner symptoms a long time, and then diagnosed with excisional biopsy from her rib bone.

Seminars in Respiratory and Critical Care Medicine, 2010

Sarcoidosis is a systemic, clinically heterogeneous disease characterized by the development of granulomas. Any organ system can be involved, and patients may present with any number of rheumatologic symptoms. There are no U.S. Food and Drug Administration-approved therapies for the treatment of sarcoidosis. Diagnosing sarcoidosis becomes challenging, particularly when its complications cause patients' symptoms to mimic other conditions, including polymyositis, Sjögren syndrome, or vasculitis. This review presents an overview of the etiology of and biomarkers associated with sarcoidosis. We then provide a detailed description of the rheumatologic manifestations of sarcoidosis and present a treatment algorithm based on current clinical evidence for patients with sarcoid arthritis. The discussion will focus on characteristic findings in patients with sarcoid arthritis, osseous involvement in sarcoidosis, and sarcoid myopathy. Arthritic conditions that sometimes coexist with sarcoidosis are described as well. We present two cases of sarcoidosis with rheumatologic manifestations. Our intent is to encourage a multidisciplinary, translational approach to meet the challenges and difficulties in understanding and treating sarcoidosis.

European Respiratory Journal, 2011

Reumatología Clínica, 2017

A 35-year-old man presented with a 3-year history of arthralgia and purple coloration of the skin of his fingers and feet. Hand and foot radiography showed cystic bone lesions on phalanges suggestive of sarcoidosis. Lab tests revealed increased liver enzymes. Liver MRI evidenced an enlarged liver and retroperitoneal lymphadenopathy. Histological analysis of the finger skin, lymph nodes and liver demonstrated the presence of granulomas, confirming the diagnosis of sarcoidosis. The patient started prednisolone with rapid improvement of the symptoms. Skin lesions are divided into two groups: specific for sarcoidosis (with granulomas, lupus pernio-like) and nonspecific (without granulomas, erythema nodosum-like). Specific cutaneous lesions usually cause no other symptoms beyond cosmetic changes. Lupus pernio stands out for having distinctive features but, to the best of our knowledge, the simultaneous involvement of both hands and feet has never been reported.

The Journal of Rheumatology, 2011

The Journal of Hand Surgery: Journal of the British Society for Surgery of the Hand, 2006

Sarcoidosis is a multisystemic granulomatous disease. In the case presented, autoamputation of the distal phalanx of a little finger of the left hand was observed. The possibility of autodigital amputation as a result of sarcoidosis is discussed.

Caspian Journal of Internal Medicine, 2018

Background: Sarcoidosis is a multisystem granulomatous disease. Coexistence with spondyloarthritis (SA) has been more described as an adverse effect of anti-TNF α therapy than an association. We report herein a case of a typical sarcoidosis confirmed by histological proofs and an advanced SA with a bamboo column. Case Presentation: A 48-years-old woman presented with inflammatory back pain for 5 years and ankle swelling for 1 year. On physical examination, she had an exaggerated dorsal kyphosis and disappearance of lumbar lordosis with limitation in motion of the cervical and lumbar spine. Laboratory tests did not show an inflammatory syndrome or hypercalcemia. Plain radiographies of the spine and pelvic revealed a triple ray appearance with sacroiliitis grade 4. Chest radiography and CT confirmed the presence of bilateral hilar lymph nodes and parenchymal nodes. Bronchoscopy and biopsies were performed showing non-calcified granulomatous reaction without cell necrosis. The diagnosis of SA was performed based on 9 points of Amor criteria associated with pulmonary sarcoidosis. She was treated with 15 mg per week of methotrexate and 1mg/kg/day of prednisone for pulmonary disease with good outcomes. Conclusions: Sarcoidosis may be associated to SA besides paradoxical drug effect. The same physio pathological pathways mediate by TNF α are arguments for association than hazardous coincidence.

Sarcoidosis, vasculitis, and diffuse lung diseases : official journal of WASOG / World Association of Sarcoidosis and Other Granulomatous Disorders, 2007

The Icelandic Sarcoidosis Study (ISS) contains all tissue-verified cases of sarcoidosis in Iceland since 1981. The present study has extended registration and verification to the start of 2004, thus covering over 23 years and a total of 234 cases. The aim of this study was to elucidate the prevalence, clinical manifestation and long-term prognosis of sarcoid arthritis in this unselected nationwide cohort. The presence of joint or muscle symptoms was registered in 20% of these cases. We used a questionnaire to register the lung and joint symptoms and all participants were offered a clinical evaluation with standardized interview and physical examination, including a count of the number of painful and/or inflamed joints. Forty-seven (20%) of the 234 individuals in the ISS reported skeletal symptoms. In thirty-nine cases (17%) it was possible to confirm a history of inflammatory joint disorder. The mean age was 45 years: women 46 years (30-66), men 43 years (28-66). In 82% of the cases...

Anais do Congresso Brasileiro de Reumatologia 2020, 2021

BACKGROUND Sarcoidosis is a systemic disease that histologically presents non-caseous granuloma and, typically, bilateral hilar adenopathy, pulmonary infiltrate, skin and/or eye lesions. Bone and joint manifestations occur less commonly. Patients with widespread disease may have impairment of peripheral appendicular skeleton in 1-13% of cases. Primary skeletal presentation is rare. Bone sarcoidosis occurs in approximately 5% of patients with sarcoidosis (range 1 to 13%), although its frequency is likely to be underestimated, as it is usually asymptomatic. Likewise, sarcoidosis rarely affects the bone marrow, with possible hematological changes. It is more common in middle-aged women and afro-descendants. It usually appears later than many other common manifestations of sarcoidosis. The case below refers to sarcoidosis with lytic lesions disseminated in the axial skeleton and long bones, in addition to marked anemia, mimicking metastatic disease. CASE REPORT Female, brown, 65 years old, diabetic started bone pain in lower limbs and scapula with six months of evolution, associated with weight loss of approximately 18 kg and bilateral inguinal lymph node enlargement. He evolved with loss of renal function, proteinuria, anemia, and hypercalcemia (Cr: 3.43, Ur: 126, Hb: 6.7, proteinuria: 1060 mg/day, ionic calcium: 7.8). Radiography of skullcap was performed, showing lytic lesions. Initially, the hypothesis of multiple myeloma was raised, with protein electrophoresis that did not show a monoclonal peak, urinary immunofixation, also without monoclonal protein and myelogram without an increase in plasma series. Chest computed tomography (CT) scan showed bilateral hilar adenopathy, scintigraphy with disseminated bone involvement in the spine, hips, ribs, skull and long bones, such as femur and humerus, compatible with sarcoidosis, but cannot rule out metastatic disease. Bone marrow biopsy with granulomatous myelitis with giant cells, in addition to lymph node biopsy with granulomatous lymphadenitis with giant cells, closing the diagnosis for sarcoidosis with bone and medullary involvement by bone marrow infiltration. CONCLUSION Sarcoidosis can affect the musculoskeletal system and bone marrow, although it is quite rare. It is a challenging diagnosis and the diagnosis of malignant diseases should be excluded initially.

Clinical …, 2007

Bone sarcoidosis of the skull is an infrequent presentation of sarcoidosis. We describe a 51-year-old man who consulted due to inflammatory-appearing nodulation in the right supraorbital region. Images showed a solitary osteolytic lesion extending to soft tissues with increased scintigraphic uptake. The anatomopathological study revealed the presence of non-caseating epithelioid granulomas, compatible with sarcoidosis. Steroid treatment led to a marked remission of the lesion, without evidence of relapse during a follow-up period of 1 year. The literature dealing with skull sarcoidosis is reviewed.

Skin Appendage Disorders, 2015

The most commonly seen nail change in sarcoidosis, often associated with chronic systemic disease, is onychodystrophy. Imaging of hands, feet and chest is of paramount importance when nail sarcoidosis is suspected, for evaluation of bone cysts and pulmonary involvement, respectively. We report 2 cases of sarcoidosis that developed nail involvement-one with pulmonary disease, and the other without any evidence of systemic involvement, which is very rare.

Shortness of Breath, 2015

Sarcoidosis is a multisystem disease of unknown etiology characterized by clusters of non-necrotizing granulomas and distortion of surrounding tissue. Although some patients are asymptomatic, sarcoidosis can cause a wide range of signs and symptoms often mimicking autoimmune rheumatologic disorders. Combined sarcoidosis and autoimmune disorders is uncommon as a result of either an University Hospital database analysis and literature review. However, given the high prevalence of autoimmunity in the general population, clinicians should be alerted to correctly diagnose and manage patients suspected to have both sarcoidosis and autoimmune disorders.

International Journal of Medical Students, 2013