Rheumatologic Manifestations of Sarcoidosis

Abstract and Introduction

Abstract

Sarcoidosis is a systemic, clinically heterogeneous disease characterized by the development of granulomas. Any organ system can be involved, and patients may present with any number of rheumatologic symptoms. There are no U.S. Food and Drug Administration-approved therapies for the treatment of sarcoidosis. Diagnosing sarcoidosis becomes challenging, particularly when its complications cause patients' symptoms to mimic other conditions, including polymyositis, Sjögren syndrome, or vasculitis. This review presents an overview of the etiology of and biomarkers associated with sarcoidosis. We then provide a detailed description of the rheumatologic manifestations of sarcoidosis and present a treatment algorithm based on current clinical evidence for patients with sarcoid arthritis. The discussion will focus on characteristic findings in patients with sarcoid arthritis, osseous involvement in sarcoidosis, and sarcoid myopathy. Arthritic conditions that sometimes coexist with sarcoidosis are described as well. We present two cases of sarcoidosis with rheumatologic manifestations. Our intent is to encourage a multidisciplinary, translational approach to meet the challenges and difficulties in understanding and treating sarcoidosis.

Introduction

Sarcoidosis is a multisystem disease of unknown etiology. Patients with sarcoidosis may develop extrapulmonary organ involvement, including rheumatologic complications. Here we will briefly review the etiology of sarcoidosis and then describe the presentations of and diagnostic findings in various rheumatologic manifestations of sarcoidosis. To highlight some of the rheumatologic complications of sarcoidosis, we also present one case of peripheral sarcoid arthritis and one case with axial sarcoid involvement. We then propose an approach for the management of patients with sarcoid arthritis in particular, an approach that borrows on the effective strategies employed for rheumatoid arthritis.

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Table 1. Recommendations on Baseline Evaluation for Starting, Resuming, or Significant Dose Increase of a Therapy in Patients with Rheumatoid Arthritis Receiving Nonbiologic and Biologic Disease-Modifying Antirheumatic Drugs*
Therapeutic Agents	CBC^†	Liver Transaminase	Creatinine	Hepatitis B and C Testing^‡	Ophthalmologic Examination^¶
Hydroxychloroquine	X	X	X		X
Leflunomide	X	X	X	X
Methotrexate	X	X	X	X
Minocycline	X	X	X
Sulfasalazine	X	X	X
All biologic agents	X	X	X

*Reproduced with permission from Saag et al.^[65]
^†CBC, complete blood count.
^‡If hepatitis risk factors are present (e.g., intravenous drug abuse, multiple sex partners in the previous 6 months, health care personnel). Evaluation might include tests for hepatitis B surface antigen, hepatitis B antibodies, hepatitis B core antibodies, and/or hepatitis C antibodies.
^¶Ophthalmologic examination is recommended within the first year of treatment. For patients in higher-risk categories (e.g., liver disease, concomitant retinal disease, and age ≥60 years), the American Academy of Ophthalmology recommends an annual follow-up eye examination

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Rheumatologic Manifestations of Sarcoidosis

Abstract and Introduction

Abstract

Introduction

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