Musculoskeletal sarcoidosis

Musculoskeletal features are reported between 4% and 38% of cases. Patients may have arthritis, periarthritis, bone disease, myositis and vaculitis (1)

Arthritis

• 25% of patients with sarcoidosis may present with arthritis or complain of arthritis with other disease features
• can either be acute or chronic arthritis
  • acute arthritis
    • typically presents as bilateral diffuse ankle swelling with or without erythema nodosum (Löfgren syndrome; more common) or as an oligoarthritis of a reactive type
    • usually the involvement is oligoarticular with both large and small joint involvement mainly in lower than the upper limb
  • chronic arthritis - the following forms (usually affecting the hands, wrists, ankles, feet and knees) of chronic arthropathy is seen in sarcoidosis patients
    • dactilytis
    • oligo or polyarthritis
    • tenosynoviti

Myopathy

• muscle involvement is seen in 50 - 80% of sarcoidosis patients
  • in a study carried out using gastrocnemius muscle biopsy on 122 patients revealed that 65 (53%) had a positive result
• but in a small number of people (5%) muscle involvement is asymptomatic
• myositis may be focal or can be widespread with generalized weakness and myalgia

Bone disease

• relatively infrequent, seen in around 5% of patients with sarcoidosis
• the condition is asymptomatic in half of the affected individuals
• typical cystic or lattice like radiographic appearance can be seen
• may be associated with dactilytis and pseudoclubbing (due to gross nail and nailbed dystrophy)

Vasculitis

• rare, but involvement of large, medium and small vessels have been described.

Reference:

• (1) Bourke b. Musculoskeletal aspect of sarcoidosis. Topical Reviews 2009;2