Skelettsarkoidose

[Granulomatous skeletal lesions]

The main granulomatous diseases of the musculoskeletal system are Langerhans cell histiocytosis, sarcoidosis, Erdheim-Chester disease (lipoidgranulomatosis) and mastocytosis. In most cases the patients have only a few symptoms, and the disease is detected coincidentally. The diagnosis is usually made by a synopsis of topographical presentation, clinical appearance and the radiological pattern (destruction, reactive new bone formation).

Musculoskeletal Manifestations of Sarcoidosis: A Review Article

BACKGROUND

Sarcoidosis is a multisystem inflammatory disease with an etiology that is not clearly understood. Amongst the different organs that may be affected, the lungs are the most common. Musculoskeletal manifestations of the disease are uncommon.

OBJECTIVES

They include arthropathy, bone lesions, or myopathy, all of which may occur as initial symptoms or develop during the course of the disease.

METHODS

Articular involvement my present as arthralgia or arthritis. Skeletal complications usually develop in the chronic state of the disease. Muscular disease is rare and usually asymptomatic. Appropriate imaging modalities including X-ray, MRI, FDG-PET/CT assist in the diagnosis of rheumatic sarcoidosis. However, biopsy is necessary for definite diagnosis.

RESULT AND CONCLUSION

In most cases of musculoskeletal involvement, NSAIDs and corticosteroids are sufficient for symptomatic management. For more resistant cases immunosuppressive drugs (i.e., methotrexate) and TNF- inhibitors are used. Our aim is to review various types of musculoskeletal involvement in sarcoidosis and their existing treatment options.

[Inflammatory muscle diseases (myositis)]

CLINICAL ISSUE

Inflammatory muscle diseases are quite heterogeneous and frequently a specific diagnosis is not easy.

STANDARD RADIOLOGICAL METHODS

Magnetic resonance imaging (MRI) is best suited to demonstrate pattern and size of inflamed muscles.

PERFORMANCE

Sensitivity of MRI in showing inflamed muscles is nearly 100%. Specificity, however, is much lower.

PRACTICAL RECOMMENDATIONS

In cases of suspected bacterial myositis, sonography may be used to exclude abscess formation prior to MRI for more precise information about inflamed muscles.