Sarcoidosis musculoskeletal system
Authors:
M. Žurek 1; P. Horák 1; M. Žurková 2; V. Lošťáková 2; T. Tichý 3
Authors‘ workplace:
III. interní klinika – nefrologická, revmatologická a endokrinologická LF UP a FN, Olomouc
1; Klinika plicních nemocí a tuberkulózy LF UP a FN, Olomouc
2; Ústav klinické a molekulární patologie LF UP, Olomouc
3
Published in:
Čes. Revmatol., 27, 2019, No. 2, p. 57-64.
Category:
Review Article
Overview
Sarcoidosis is a multisystem granulomatous disease of unknown etiology, most commonly manifested by intrathoracic involvement with bilateral hilar lymphadenopathy and / or pulmonary infiltrates. Ophthalmic and skin lesions are the most common extrapulmonary manifestations, liver, spleen, lymph nodes, salivary glands, heart, nervous system, muscles and bones, rarely other organs, may also be affected. Musculoskeletal manifestations is present in up to 1/3 of patients and their spectrum is broad from simple arthralgia to lytic bone lesion. Inflammatory tendon lesions and periarticular edema are more common than joint synovitis. Despite current knowledge of the pathogenesis of the disease, the diagnosis of sarcoidosis of the musculoskeletal system is difficult. The definitive diagnosis is often determined by histological finding of sarcoid granuloma in tissues in combination with clinical manifestations. Musculoskeletal involvement usually occurs early in the disease. New imaging methods, especially PET/CT using fluorodeoxyglucose, are useful for assessing the extent of disease and determining disease activity. Glucocorticoids are the first-line treatment in the management of systemic symptoms of sarcoidosis, methotrexate or other disease-modifying drugs can be used as corticosteroid-sparing medications. Biological therapy, in particular TNF alpha inhibitors, has a place in the treatment of refractory disease, but the evidence for its efficacy is not clear.
Keywords:
arthritis – Sarcoidosis – granuloma – musculoskeletal system – bone lesions
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