Sarcoidosis (musculoskeletal manifestations)

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Musculoskeletal manifestations of sarcoidosis occur in ~20% (range 4-38%) of patients with sarcoidosis and include joint involvement, bone lesions, and muscular disease. Approximately 25% of patients with sarcoidosis have associated arthropathy.

Pathology

joints: joint involvement in sarcoidosis
- radiographically identifiable pathology is rare
- can be acute occurring isolated or as part of the Löfgren syndrome
- less commonly, chronic arthritis presenting as non-deforming granulomatous synovitis or deforming non-erosive arthritis (Jacoud's deformity)
- dactylitis and/or tenosynovitis
- commonest joints to be involved are the ankles, knees, elbows, and phalanges of the hands and feet
- joint space narrowing is unusual
muscles: muscle involvement in sarcoidosis
- muscles involvement occurs around 50-80%, but symptomatic in only 0.5-2.5%, mostly when the diaphragm or extraocular muscles are involved
- can be chronic proximal myopathy or less commonly acute mimicking polymyositis
- nodular pattern myopathy manifest as single or multiple painful nodules
bones: skeletal sarcoidosis
- hands are mainly affected
  - changes seen in the middle and distal phalanges tend to be more advanced than those in the proximal phalanges and metacarpal bones
- lace-like pattern of bone destruction in the metaphysis
- cystic bone lesions with well-defined margins and lytic bone lesions with periosteal reaction
- remodeling of the cortex of phalanges, in which the concave shaft is converted into a tubular structure
- sclerotic bone lesions
- osteopenia/osteoporosis