Костно-мышечные проявления саркоидоза: взгляд ревматолога

Саркоидоз – системное воспалительное заболевание, имитирующее другие нозологические формы благодаря разнообразию своих клинических симптомов. В статье приводится анализ костно-мышечных проявлений саркоидоза с позиции ревматолога. Описаны симптомы со стороны опорно-двигательного аппарата, характерные как для саркоидоза, так и для ревматических заболеваний, включающие артропатию, миопатию и поражение костей. Особое внимание уделено возможности наличия у пациента сочетанной патологии: саркоидоза и заболевания ревматического профиля. Обсуждается сложность диагностики при неоднозначности результатов клинического осмотра, лабораторных анализов и инструментальных исследований. Обоснована важность использования биопсии в выявлении саркоидоза. Приведены отличительные клинические, лабораторные и гистологические признаки заболеваний, встречающихся в практике ревматолога, в сравнении с саркоидозом. Отмечено, что важную роль в верификации диагноза играет оценка иммунологических маркеров системных заболеваний соединительной ткани. Рассматриваются принципы дифференциальной диагностики саркоидоза с ревматоидным артритом, аксиальным спондилоартритом, псориатическим артритом, АНЦА-ассоциированными васкулитами, системной красной волчанкой, системным склерозом, первичным синдромом Шегрена, IgG4-ассоциированным заболеванием и воспалительными миопатиями. Обоснована важность использования мультидисциплинарного подхода к диагностике и повышению осведомленности врачей о клинических проявлениях саркоидоза и ревматических болезней.

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66. Ekin, A. Rheumatologic perspectives on sarcoidosis: predicting sarcoidosis-associated arthritis through comprehensive clinical and laboratory assessment / A. Ekin [et al.] // J. Clin. Med. – 2024. – Vol. 24, № 13. – Article number: 7563. doi: 10.3390/jcm13247563

67. Hassine, B. Osseous sarcoidosis: a multicenter retrospective case-control study of 48 patients / B. Hassine [et al.] / Jt. Bone Spine. – 2019. – Vol. 86, № 6. – P. 789–793. doi: 10.1016/j.jbspin.2019.07.009

68. Aptel, S. Multimodality evaluation of musculoskeletal sarcoidosis: imaging findings and literature review / S. Aptel [et al.] // Diagn Interv Imaging. – 2016. – Vol. 97, № 1. – P. 5–18. doi: 10.1016/j.diii.2014.11.038

69. Moore, S. L. MRI of sarcoidosis patients with musculoskeletal symptoms / S. L. Moore, A. Teirstein, C. Golimbu // AJR Am J Roentgenol. – 2005. – Vol. 185, № 1. – P. 154–159. doi: 10.2214/ajr.185.1.01850154

70. Guimarães, B. J. Radiologic manifestations of musculoskeletal sarcoidosis / B. J. Guimarães [et al.] // Curr Rheumatol Rep. – 2019. – Vol. 21, № 3. – Article number: 7. doi: 10.1007/s11926-019-0806-0

71. Erb, N. An assessment of back pain and the prevalence of sacroiliitis in sarcoidosis / N. Erb [et al.] // Chest. – 2005. – Vol. 127, № 1. – P. 192–196. doi: 10.1378/chest.127.1.192

72. Shaharir, S. S. Sarcoid myopathy mimicking polymyositis: a case report and pool analysis of the literature reviews / S. S. Shaharir [et al.] // Acta Med Iran. – 2017. – Vol. 55, № 12. – P. 800–806. PMID: 29373888

73. ten Dam, L. Clinical characteristics and outcome in muscular sarcoidosis: a retrospective cohort study and literature review / L. ten Dam [et al.] // Neuromuscul Disord. – 2022. – Vol. 32, № 7. – P. 557–563. doi: 10.1016/j.nmd.2022.05.012

74. Akaike, G. PET/CT in the diagnosis and workup of sarcoidosis: focus on atypical manifestations / G. Akaike [et al.] // Radiographics. – 2018. – Vol. 38, № 5. – P. 1536–1549. doi: 10.1148/rg.2018180053

75. Chompoopong, P. Symptomatic myopathies in sarcoidosis: disease spectrum and myxovirus resistance protein A expression / P. Chompoopong [et al.] // Rheumatology (Oxford). – 2023. – Vol. 62, № 7. – P. 2556–2562. doi: 10.1093/rheumatology/keac668

76. Korsten, P. Sarcoidosis and autoimmune diseases / P. Korsten [et al.] // Current Opinion in Pulmonary Medicine. – 2018. – Vol. 24, № 5. – P. 504–512. doi: 10.1097/MCP.0000000000000500

77. Nessrine, A. Musculoskeletal involvement in sarcoidosis / A. Nessrine, A. F. Zahra, H. J. Taoufik // Bras Pneumol. – 2014. – Vol. 40, № 2. – P. 175–182. doi: 10.1590/S1806-37132014000200012

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80. Zhou, Y. Balancing altered calcium metabolism with bone health in sarcoidosis / Y. Zhou, E. E. Lower // Semin. Respir. Crit. Care Med. – 2020. – Vol. 41, № 5. – P. 618–625. doi: 10.1055/s-0040-1713009