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Muskuloskelettale Manifestationen der Sarkoidose

Musculoskeletal manifestations of sarcoidosis

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Zusammenfassung

Manifestationen am Bewegungsapparat sind bei der Sarkoidose ein häufiges Symptom. Rheumatologen treffen das Krankheitsbild regelhaft an. Die vorliegende Übersichtsarbeit gibt einen aktuellen Überblick über die rheumatologisch relevanten Befunde und eingesetzte Therapien. Die häufigste Manifestation ist das Löfgren-Syndrom, das durch Sprunggelenkperiarthritis, bihiläre Lymphadenopathie und Erythema nodosum gekennzeichnet ist und eine exzellente Prognose hat. Chronische Arthritiden im Rahmen einer Sarkoidose manifestieren sich am häufigsten durch Oligoarthritis, was die Abgrenzung zu Spondylarthropathien erschweren kann, insbesondere wenn eine Sakroiliitis oder andere Befunde wie Enthesitis oder Daktylitis vorliegen. Isolierte vertebrale granulomatöse Veränderungen sind selten und erfordern den Ausschluss infektiöser und maligner Ursachen mittels Biopsie, da es keine spezifischen bildgebenden Befunde gibt. Der Granulomnachweis in Muskelgewebe gelingt häufig, eine klinische Myopathie liegt allerdings nur bei 1–2 % der Patienten vor. Das therapeutische Ansprechen bei den verschiedenen Formen kann sehr unterschiedlich sein. Therapeutisch spielen in erster Linie nichtsteroidale Antirheumatika und Glukokortikoide in niedriger bis mittlerer Dosis eine Rolle, bei Ineffektivität oder Unverträglichkeit kommen jedoch auch steroidsparende Immunsuppressiva zum Einsatz. Insgesamt ist die Evidenzlage aufgrund weniger Studien gering. Bei der Substitution von Vitamin D muss berücksichtigt werden, dass Hyperkalzämien auch bei Standarddosierungen entstehen können und der optimale therapeutische Bereich zur Prävention einer therapiebedingten Osteoporose bei der Sarkoidose nicht etabliert ist.

Abstract

Musculoskeletal manifestations in the context of sarcoidosis are frequently observed. The rheumatologist regularly encounters this disease in clinical practice. In the present review, we aim to give a current overview of the manifestations and treatments relevant to the practicing rheumatologist. The most frequently encountered manifestation is Lofgren’s syndrome, which is characterized by bilateral ankle periarthritis, bilateral hilar lymphadenopathy, and erythema nodosum and has an excellent prognosis. Chronic arthropathy most commonly manifests as oligoarthritis, which sometimes hampers its differentiation from spondylarthropathies, especially when sacroiliitis, enthesitis or dactylitis are simultaneously present. Isolated vertebral granulomas are rare and require infectious and malignant disorders to be excluded, since there are no specific imaging findings that are exclusively found in vertebral sarcoidosis. The presence of granulomas in skeletal muscle is common in muscle biopsies, whereas clinically overt myopathy is present in only around 1–2% of patients. Therapeutic responses vary among the different clinical phenotypes. Non-steroidal anti-inflammatory drugs and low to medium dose glucocorticoids are the first-line therapy for musculoskeletal manifestations and often lead to adequate disease control in acute sarcoidosis. When these are ineffective or not tolerated, steroid-sparing agents are increasingly used in chronic sarcoidosis. Evidence for all medications used in sarcoid-related arthritis is comparatively scant. When supplementing vitamin D, the possible development of hypercalcemia, even at standard doses, needs to be considered; the optimal therapeutic levels for the prevention of medication-induced osteoporosis in sarcoidosis have not been firmly established.

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Authors and Affiliations

  1. Klinik für Nephrologie und Rheumatologie, Universitätsmedizin Göttingen, Robert-Koch-Str. 40, 37075, Göttingen, Deutschland

    P. Korsten

  2. Poliklinik, Funktionsbereich und Hiller Forschungszentrum für Rheumatologie, Universitätsklinikum der Heinrich-Heine-Universität Düsseldorf, Düsseldorf, Deutschland

    G. Chehab

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P. Korsten, Göttingen

R. Bergner, Ludwigshafen

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Korsten, P., Chehab, G. Muskuloskelettale Manifestationen der Sarkoidose. Z Rheumatol 76, 408–414 (2017). https://doi.org/10.1007/s00393-017-0313-5

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