Bone Sarcoidosis

 

Sarcoidosis is a progressive systemic granulomatous disease involving possibly any organ or tissue in our body. This is an article that will be looking into the involvement of the bones in sarcoidosis.

Sarcoidosis of the bones is very difficult to diagnose, primarily due to the fact that it can mimic so many other disorders. For example, Sarcoidosis in the long bones mimics tuberculosis in those sites.

Differential Diagnosis of Bone Sarcoidosis

Differential diagnosis includes:

• Tuberculosis
• Histoplasmosis
• Coccidioidomycosis
• Leprosy
• Brucellosis
• Syphilis
• Wegener’s granulomatosis
• Eosinophilic granuloma
• Multiple myeloma
• Lymphoma

There is record of bone sarcoidosis starting from the age of a few months and up to the 8th decade of life. Sarcoid involvement of the bones is more often involved in women, and among women it i more common in those of African descent. It is fair to say that the frequency of bone sarcoidosis varies from 3 to 13 %.

Bone sarcoidosis is characterized by lesions in the bones, who are distributed bilaterally.

 In sarcoid bone lesions, the cortical borders of the bones are well preserved. Articular disease is usually manifested by soft tissue swelling and effusions. In more severe cases, the lesions tend to extend into the joint spaces. But, there is no calcification.

When Sarcoidosis involves the vertebrae, symptoms, such as back pain with activity, are almost always present. Such pain can be relieved somewhat by frequent rests. Depending on the location of the involved vertebrae there is evidence of neurological pain. A needle or open bone biopsy is needed for accurate diagnosis.

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When granulomatous areas are noted in ribs, other bone involvement is often
part of the whole picture and frequently without symptoms. It is often diagnosed
when unrelated x-ray examination is necessary. Corticosteroids were effective in
treatment.

Persistent and progressive low back pain is the complaint of some patients with pelvic bone involvement. In most cases reviewed by PK Rohatgi, there was unified increase in bone density, and in two cases the pelvic x-ray was normal. CAT scan confirmed the diagnosis.

However, when it comes to what causes the lesions in the bones in sarcoidosis, the question remains unanswered. Since the lesions occur mostly in non-weight bearing bones (hands), they show features of increased bone resorption rather than bone production.

Radiology does not exactly serve the purpose in the process of diagnosis of bone sarcoidosis, since only the gross changes are evident. Because bone lesions may remain asymptomatic and are discovered  incidentally in many cases, the exact nature, distribution, and progression of lesions remain unknown.

Granulomas in the bone (especially in the long and short bones) can spread
along and around blood vessels in the compact bones and can involve bone
covering and ends of bone at the joints, and still not be evident on x-ray.

Types of Bone lesions in sarcoidosis

Lytic Lesions

Lytic lesion is the same as a bone cyst. Theses cysts usually reflect an destructive osteoporotic process. Nasal bone lesions are less common, always small and may appear as lytic defects on a background of osteoporosis.

Destructive Lesions

In more severe cases and in the more sclerotic phase, the bone may develop multiple fractures. If joint destruction occurs, it is localized to the subchondral areas of the bone. Fractures are rare, but may occur if extensive lytic lesions are present.

 

Periosteal Reaction

Periostitis is a medical condition caused by inflammation of the periosteum, a layer of connective tissue that surrounds bone. The condition is generally chronic, and is marked by tenderness and swelling of the bone and an aching pain.

Periostitis is uncommon although it may occur.

Digital Clubbing

Clubbing (also known as "Drumstick fingers," "Hippocratic fingers," and "Watch-glass nails") is a deformity of the fingers and fingernails that is associated with a number of diseases, mostly of the heart and lungs.

It can be one of the signs that there is bone involvement in sarcoidosis.

Sarcoidosis and the muscles

Sarcoidosis of the muscles may manifest in the following ways.

• Asymptomatic granulomatous muscle involvement

Frequently in active disease, especially in patients with
erythema nodosum.

• Palpable muscle nodules

A rare type of muscle lesion.

• Polymyositis

Symptomatic muscular sarcoidosis, seen more often
in women than in men, characterized by fever, severe
muscle pain, and tenderness involving principally the
proximal shoulder and pelvic girdle muscles.

• Chronic myopathy

Muscle wasting and weakness indicate chronic myopathy;
associated with chronic multisystem disease.

 

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