Advertisement

Zeitschrift für Rheumatologie

, Volume 76, Issue 5, pp 408–414 | Cite as

Muskuloskelettale Manifestationen der Sarkoidose

  • P. Korsten
  • G. Chehab
Leitthema

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.

Schlüsselwörter

Muskuloskelettale Erkrankungen Arthritis Myopathien Immunsuppressiva Biologika 

Musculoskeletal manifestations of sarcoidosis

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.

Keywords

Musculoskeletal diseases Arthritis Myopathic conditions Immunosuppressants Biologic agents 

Notes

Einhaltung ethischer Richtlinien

Interessenkonflikt

P. Korsten und G. Chehab geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

Literatur

  1. 1.
    Al-Kofahi K, Korsten P, Ascoli C et al (2016) Management of extrapulmonary sarcoidosis: challenges and solutions. Ther Clin Risk Manag 12:1623–1634. doi: 10.2147/TCRM.S74476 CrossRefPubMedPubMedCentralGoogle Scholar
  2. 2.
    Anandacoomarasamy A, Peduto A, Howe G et al (2007) Magnetic resonance imaging in Löfgren’s syndrome: demonstration of periarthritis. Clin Rheumatol 26:572–575. doi: 10.1007/s10067-006-0360-9 CrossRefPubMedGoogle Scholar
  3. 3.
    Aptel S, Lecocq-Teixeira S, Olivier P et al (2016) Multimodality evaluation of musculoskeletal sarcoidosis: Imaging findings and literature review. Diagn Interv Imaging 97:5–18. doi: 10.1016/j.diii.2014.11.038 CrossRefPubMedGoogle Scholar
  4. 4.
    Baltzer G, Behrend H, Behrend T, Dombrowski H (1970) Incidence of cystic bone alterations (ostitis cystoides multiplex Jüngling) in sarcoidosis. Dtsch Med Wochenschr 95:1926–1929. doi: 10.1055/s-0028-1108755 CrossRefPubMedGoogle Scholar
  5. 5.
    Baughman RP, Janovcik J, Ray M et al (2013) Calcium and vitamin D metabolism in sarcoidosis. Sarcoidosis Vasc Diffuse Lung Dis 30:113–120PubMedGoogle Scholar
  6. 6.
    Birnbaum AD, Rifkin LM (2014) Sarcoidosis: sex-dependent variations in presentation and management. J Ophthalmol 2014:236905. doi: 10.1155/2014/236905 CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    Bolland MJ, Wilsher ML, Grey A et al (2015) Bone density is normal and does not change over 2 years in sarcoidosis. Osteoporos Int 26:611–616. doi: 10.1007/s00198-014-2870-7 CrossRefPubMedGoogle Scholar
  8. 8.
    Dragnev D, Barr D, Kulshrestha M, Shanmugalingam S (2013) Sarcoid panuveitis associated with etanercept treatment, resolving with adalimumab. BMJ Case Rep. doi: 10.1136/bcr-2013-200552 PubMedPubMedCentralGoogle Scholar
  9. 9.
    Erb N, Cushley MJ, Kassimos DG et al (2005) An assessment of back pain and the prevalence of sacroiliitis in sarcoidosis. Chest 127:192–196. doi: 10.1378/chest.127.1.192 CrossRefPubMedGoogle Scholar
  10. 10.
    Fayad F, Lioté F, Berenbaum F et al (2006) Muscle involvement in sarcoidosis: a retrospective and followup studies. J Rheumatol 33:98–103PubMedGoogle Scholar
  11. 11.
    Glennås A, Kvien TK, Melby K et al (1995) Acute sarcoid arthritis: occurrence, seasonal onset, clinical features and outcome. Br J Rheumatol 34:45–50CrossRefPubMedGoogle Scholar
  12. 12.
    Gran JT, Bøhmer E (1996) Acute sarcoid arthritis: a favourable outcome? A retrospective survey of 49 patients with review of the literature. Scand J Rheumatol 25:70–73CrossRefPubMedGoogle Scholar
  13. 13.
    Grunewald J, Eklund A (2007) Sex-specific manifestations of Löfgren’s syndrome. Am J Respir Crit Care Med 175:40–44. doi: 10.1164/rccm.200608-1197OC CrossRefPubMedGoogle Scholar
  14. 14.
    Grunewald J, Eklund A (2009) Löfgren’s syndrome: human leukocyte antigen strongly influences the disease course. Am J Respir Crit Care Med 179:307–312. doi: 10.1164/rccm.200807-1082OC CrossRefPubMedGoogle Scholar
  15. 15.
    Iannuzzi MC, Rybicki BA, Teirstein AS (2007) Sarcoidosis. N Engl J Med 357:2153–2165. doi: 10.1056/NEJMra071714 CrossRefPubMedGoogle Scholar
  16. 16.
    Kamphuis LS, Bonte-Mineur F, van Laar JA et al (2014) Calcium and vitamin D in sarcoidosis: is supplementation safe? J Bone Miner Res 29:2498–2503. doi: 10.1002/jbmr.2262 CrossRefPubMedGoogle Scholar
  17. 17.
    Kellner H, Späthling S, Herzer P (1992) Ultrasound findings in Löfgren’s syndrome: is ankle swelling caused by arthritis, tenosynovitis or periarthritis? J Rheumatol 19:38–41PubMedGoogle Scholar
  18. 18.
    Kobak S, Sever F, Ince O, Orman M (2014) The prevalence of sacroiliitis and spondyloarthritis in patients with sarcoidosis. Arthritis Rheumatol 66:S546–S546Google Scholar
  19. 19.
    Kobak S, Yilmaz H, Sever F et al (2014) The prevalence of antinuclear antibodies in patients with sarcoidosis. Autoimmune Dis 2014:351852. doi: 10.1155/2014/351852 PubMedPubMedCentralGoogle Scholar
  20. 20.
    Kobak S, Ylmaz H, Sever F et al (2014) Anti-cyclic citrullinated peptide antibodies in patients with sarcoidosis. Sarcoidosis Vasc Diffuse Lung Dis 31:206–210PubMedGoogle Scholar
  21. 21.
    Korsten P, Mirsaeidi M, Sweiss NJ (2013) Nonsteroidal therapy of sarcoidosis. Curr Opin Pulm Med 19:516–523. doi: 10.1097/MCP.0b013e3283642ad0 CrossRefPubMedPubMedCentralGoogle Scholar
  22. 22.
    Korsten P, Sweiss NJ, Nagorsnik U et al (2010) Drug-induced granulomatous interstitial nephritis in a patient with ankylosing spondylitis during therapy with adalimumab. Am J Kidney Dis 56:e17–21. doi: 10.1053/j.ajkd.2010.08.019 CrossRefPubMedPubMedCentralGoogle Scholar
  23. 23.
    Le Bras E, Ehrenstein B, Fleck M, Hartung W (2014) Evaluation of ankle swelling due to Lofgren’s syndrome: a pilot study using B‑mode and power Doppler ultrasonography. Arthritis Care Res 66:318–322. doi: 10.1002/acr.22099 CrossRefGoogle Scholar
  24. 24.
    Le Roux K, Streichenberger N, Vial C et al (2007) Granulomatous myositis: a clinical study of thirteen cases. Muscle Nerve 35:171–177. doi: 10.1002/mus.20683 CrossRefPubMedGoogle Scholar
  25. 25.
    Lofgren S, Lundback H (1952) The bilateral hilar lymphoma syndrome; a study of the relation to age and sex in 212 cases. Acta Med Scand 142:259–264CrossRefPubMedGoogle Scholar
  26. 26.
    Mañá J, Gómez-Vaquero C, Montero A et al (1999) Löfgren’s syndrome revisited: a study of 186 patients. Am J Med 107:240–245CrossRefPubMedGoogle Scholar
  27. 27.
    Mañá J, Montero A, Vidal M et al (2003) Recurrent sarcoidosis: a study of 17 patients with 24 episodes of recurrence. Sarcoidosis Vasc Diffuse Lung Dis 20:212–221PubMedGoogle Scholar
  28. 28.
    Mañá J, Salazar A, Manresa F (1994) Clinical factors predicting persistence of activity in sarcoidosis: a multivariate analysis of 193 cases. Respir Int Rev Thorac Dis 61:219–225Google Scholar
  29. 29.
    Maturu VN, Rayamajhi SJ, Agarwal R et al (2016) Role of serial F‑18 FDG PET/CT scans in assessing treatment response and predicting relapses in patients with symptomatic sarcoidosis. Sarcoidosis Vasc Diffuse Lung Dis 33:372–380PubMedGoogle Scholar
  30. 30.
    Matuszak J, Durckel J, Sibilia J et al (2016) Is Sarcoid Dactylitis worse than we expect? Arthritis Rheumatol 68:417. doi: 10.1002/art.39457 CrossRefPubMedGoogle Scholar
  31. 31.
    Montemurro L, Fraioli P, Riboldi A et al (1990) Bone loss in prednisone treated sarcoidosis: a two-year follow-up. Ann Ital Med Interna Organo Uff Della Soc Ital Med Interna 5:164–168Google Scholar
  32. 32.
    Moore SL, Kransdorf MJ, Schweitzer ME et al (2012) Can sarcoidosis and metastatic bone lesions be reliably differentiated on routine MRI? AJR Am J Roentgenol 198:1387–1393. doi: 10.2214/AJR.11.7498 CrossRefPubMedGoogle Scholar
  33. 33.
    Ost D, Yeldandi A, Cugell D (1995) Acute sarcoid myositis with respiratory muscle involvement. Case report and review of the literature. Chest 107:879–882CrossRefPubMedGoogle Scholar
  34. 34.
    Otake S (1994) Sarcoidosis involving skeletal muscle: imaging findings and relative value of imaging procedures. AJR Am J Roentgenol 162:369–375. doi: 10.2214/ajr.162.2.8310929 CrossRefPubMedGoogle Scholar
  35. 35.
    Rúa-Figueroa I, Gantes MA, Erausquin C et al (2002) Vertebral sarcoidosis: clinical and imaging findings. Semin Arthritis Rheum 31:346–352CrossRefPubMedGoogle Scholar
  36. 36.
    Saidenberg-Kermanac’h N, Semerano L, Nunes H et al (2014) Bone fragility in sarcoidosis and relationships with calcium metabolism disorders: a cross sectional study on 142 patients. Arthritis Res Ther 16:R78. doi: 10.1186/ar4519 CrossRefPubMedPubMedCentralGoogle Scholar
  37. 37.
    Sanmaneechai O, Swenson A, Gerke AK et al (2015) Inclusion body myositis and sarcoid myopathy: coincidental occurrence or associated diseases. Neuromuscul Disord 25:297–300. doi: 10.1016/j.nmd.2014.12.005 CrossRefPubMedGoogle Scholar
  38. 38.
    Scharkoff T (1993) Epidemiology of sarcoidosis. Pneumologie 47:588–592PubMedGoogle Scholar
  39. 39.
    Silverstein A, Siltzbach LE (1969) Muscle involvement in sarcoidosis. Asymptomatic, myositis, and myopathy. Arch Neurol 21:235–241CrossRefPubMedGoogle Scholar
  40. 40.
    Sweiss NJ, Lower EE, Korsten P et al (2011) Bone health issues in sarcoidosis. Curr Rheumatol Rep 13:265–272. doi: 10.1007/s11926-011-0170-1 CrossRefPubMedPubMedCentralGoogle Scholar
  41. 41.
    Sweiss NJ, Patterson K, Sawaqed R et al (2010) Rheumatologic manifestations of sarcoidosis. Semin Respir Crit Care Med 31:463–473. doi: 10.1055/s-0030-1262214 CrossRefPubMedPubMedCentralGoogle Scholar
  42. 42.
    Tejera Segura B, Holgado S, Mateo L et al (2014) Löfgren syndrome: a study of 80 cases. Med Clin (Barc) 143:166–169. doi: 10.1016/j.medcli.2014.02.029 CrossRefGoogle Scholar
  43. 43.
    Thelier N, Assous N, Job-Deslandre C et al (2008) Osteoarticular involvement in a series of 100 patients with sarcoidosis referred to rheumatology departments. J Rheumatol 35:1622–1628PubMedGoogle Scholar
  44. 44.
    Ungprasert P, Crowson CS, Matteson EL (2015) Clinical characteristics of sarcoid arthropathy: a population-based study. Arthritis Care Res. doi: 10.1002/acr.22737 Google Scholar
  45. 45.
    Ungprasert P, Crowson CS, Matteson EL (2016) Seasonal variation in incidence of sarcoidosis: a population-based study, 1976-2013. Thorax. doi: 10.1136/thoraxjnl-2016-209032 PubMedGoogle Scholar
  46. 46.
    Valeyre D, Bernaudin J‑F, Uzunhan Y et al (2014) Clinical presentation of sarcoidosis and diagnostic work-up. Semin Respir Crit Care Med 35:336–351. doi: 10.1055/s-0034-1381229 CrossRefPubMedGoogle Scholar
  47. 47.
    Valeyre D, Prasse A, Nunes H et al (2014) Sarcoidosis. Lancet 383:1155–1167. doi: 10.1016/S0140-6736(13)60680-7 CrossRefPubMedGoogle Scholar
  48. 48.
    Visser H, Vos K, Zanelli E et al (2002) Sarcoid arthritis: clinical characteristics, diagnostic aspects, and risk factors. Ann Rheum Dis 61:499–504. doi: 10.1136/ard.61.6.499 CrossRefPubMedPubMedCentralGoogle Scholar
  49. 49.
    Wendling D, Prati C (2014) Paradoxical effects of anti-TNF-α agents in inflammatory diseases. Expert Rev Clin Immunol 10:159–169. doi: 10.1586/1744666X.2014.866038 CrossRefPubMedGoogle Scholar
  50. 50.
    Wolfe SM, Pinals RS, Aelion JA, Goodman RE (1987) Myopathy in sarcoidosis: clinical and pathologic study of four cases and review of the literature. Semin Arthritis Rheum 16:300–306CrossRefPubMedGoogle Scholar
  51. 51.
    Ziegenhagen MW, Rothe ME, Schlaak M, Müller-Quernheim J (2003) Bronchoalveolar and serological parameters reflecting the severity of sarcoidosis. Eur Respir J 21:407–413CrossRefPubMedGoogle Scholar
  52. 52.
    Zisman DA, Biermann JS, Martinez FJ et al (1999) Sarcoidosis presenting as a tumorlike muscular lesion. Case report and review of the literature. Medicine (Baltimore) 78:112–122CrossRefGoogle Scholar
  53. 53.
    Zisman DA, Shorr AF, Lynch JP (2002) Sarcoidosis involving the musculoskeletal system. Semin Respir Crit Care Med 23:555–570. doi: 10.1055/s-2002-36520 CrossRefPubMedGoogle Scholar
  54. 54.
    N.A. (2001) Recommendations for the prevention and treatment of glucocorticoid-induced osteoporosis: 2001 update. American College of Rheumatology Ad Hoc Committee on Glucocorticoid-Induced Osteoporosis. Arthritis Rheum 44:1496–1503. doi: 10.1002/1529-0131(200107)44:7 CrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2017

Authors and Affiliations

  1. 1.Klinik für Nephrologie und RheumatologieUniversitätsmedizin GöttingenGöttingenDeutschland
  2. 2.Poliklinik, Funktionsbereich und Hiller Forschungszentrum für RheumatologieUniversitätsklinikum der Heinrich-Heine-Universität DüsseldorfDüsseldorfDeutschland

Personalised recommendations