Sarcoidosis (musculoskeletal manifestations)

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.


  • 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
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