Musculoskeletal manifestations of sarcoidosis: perspective of a rheumatologist

Sarcoidosis is a systemic inflammatory disease which clinical manifestations mimic the signs of other pathologies. The authors of the article provide the analysis of musculoskeletal manifestations of sarcoidosis from the perspective of a rheumatologist. Signs from the musculoskeletal system, characteristic of sarcoidosis and rheumatic diseases, are arthropathy, myopathy and bone involvement. Special attention is paid by authors to the possibility of combining sarcoidosis and rheumatic diseases in the same patient. Difficulties of diagnosing are associated with ambiguity of the results of clinical examination, laboratory tests and instrumental studies. Biopsy plays an important role in the diagnosis of sarcoidosis. The article presents distinctive clinical, laboratory and histological signs of the rheumatic diseases in comparison with sarcoidosis. Immunological markers of systemic connective tissue diseases are very helpful for establishing the diagnosis. The article outlines the principles of differential diagnosis of sarcoidosis and rheumatoid arthritis, axial spondyloarthritis, psoriatic arthritis, ANCA-associated vasculitis, systemic lupus erythematosus, systemic sclerosis, primary Sjogren’s syndrome, IgG4-associated disease and inflammatory myopathies. The authors substantiate the importance of using a multidisciplinary approach to diagnosis and raising doctors’ awareness of the clinical manifestations of sarcoidosis and rheumatic diseases.

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28. 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

29. 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

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31. 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

32. 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

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34. 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

35. 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

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37. 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

38. Chuchalin, A. G. Sarkoidoz: federal’nye klinicheskie rekomendacii po diagnostike i lecheniju [Sarcoidosis: Federal Clinical Guidelines for Diagnosis and Treatment] / A. G. Chuchalin [i dr.] // Pul’monologija. – 2022. – № 6. – S. 806–833. [in Russian]. doi: 10.18093/0869-0189-2022-32-6-806-833

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41. Neves, F. S. Sarcoidosis: a general overview / F. S. Neves [et al.] // Adv Rheumatol. – 2024. – Vol. 64, № 1. – Article number: 57. doi: 10.1186/s42358-024-00381-z

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44. da Silva, I. S. F. Clinical manifestations of sarcoidosis / I. S. F. da Silva [et al.] // IntechOpen Limited – 2023. – [Электронный ресурс]. – Режим доступа: https:// www.intechopen.com/chapters/1149586. – Дата доступа: 12.04.2026. doi: 10.5772/intechopen. 1002282

45. Day, J. Rheumatic Manifestations of Sarcoidosis / J. Day, P. D.H. Hamann / Diagnostics. – 2024. – Vol. 24, № 14. – Article number: 2842. doi: 10.3390/diagnostics1424284

46. Karabulut, Y. Perspective of sarcoidosis in terms of rheumatology: a single-center rheumatology clinic experience / Y. Karabulut [et al.] // Rheumatol. Int. – 2022. – Vol. 42, № 12. – P. 2191–2197. doi: 10.1007/s00296-02205193-2

47. Gökten, D. B. Sarcoidosis from the perspective of rheumatology: three years of experience / D. B. Gökten, R. Mercan // Namik Kemal Med J. – 2024. – Vol. 12, № 1. – P. 1–7. doi:10.4274/nkmj.galenos.2024.30316

48. Nicolau, R. Systemic sclerosis and sarcoidosis: an exceptional coexistence / R. Nicolau [et al.] // ARP Rheumatol. – 2022. – № 3. – P. 330–331. PMID: 35924356

49. Wu, C.-H. Comorbid autoimmune diseases in patients with sarcoidosis: a nationwide case-control study in Taiwan / C.-H. Wu [et al.] // J Dermatol. – 2017. – Vol. 44, № 4. – P. 423–430. doi: 10.1111/1346-8138.13654

50. Yildiz, F. Concomitant autoimmune diseases in patients with sarcoidosis in Turkey / F. Yildiz [et al.] // Arch Rheumatol. – 2020. – Vol. 35, № 2. – P. 259–263. doi: 10.46497/ArchRheumatol.2020.7649

51. Brito-Zerón, P. Coexistence of immune-mediated diseases in sarcoidosis. Frequency and clinical significance in 1737 patients / P. Brito-Zerón [et al.] // Joint Bone Spine. – 2021. – Vol. 88, № 6. – Article number: 105236. doi: 10.1016/j.jbspin.2021.105236

52. Toussirot, E. TNFα blocking agents and sarcoidosis: an update / E. Toussirot, E. Pertuiset // Rev Med Interne. – 2010. – Vol. 31, № 12. – P. 828–837. doi: 0.1016/j.revmed.2010.02.007

53. Theunssens, X. Anti-TNF induced sarcoidosis-like disease in rheumatoid arthritis patients: review cases from the RA UCLouvain Brussels cohort / X. Theunssens [et al.] // Rheumatol Ther. – 2022. – Vol. 9, № 2. – P. 763–770. doi: 10.1007/s40744-022-00424-1

54. Golovina, O. A. Sochetanie revmatoidnogo artrita i sarkoidoza, debjutirovavshego na fone terapii rituksimabom: klinicheskij sluchaj i obzor literatury [Combination of rheumatoid arthritis and sarcoidosis debuting during rituximab therapy: a case report and literature review] / O. A. Golovina, N. V. Demidova, A. V. Alekseeva // Nauchno-prakticheskaja revmatologija. – 2021. – № 5. – S. 625–630. [in Russian]. doi:10.47360/1995-4484-2021-625-630 [In Russian]

55. Chatham, W. Rheumatic manifestations of systemic disease: sarcoidosis / W. Chatham // Curr Opin Rheumatol. – 2010. – Vol. 85, № 22. – P. 85–90. doi: 10.1097/BOR.0b013e328333ba74

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57. Kobak S. Sarcoidosis: a rheumatologist’s perspective / S. Kobak / Ther Adv Musculoskelet Dis. – 2015. – Vol. 7, № 5. – P. 196–205. doi: 10.1177/1759720X15591310

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60. Pérez-Garza, D. M. Erythema nodosum: a practical approach and diagnostic algorithm / D. M. Pérez-Garza [et al.] / Am J Clin Dermatol. – 2021. – Vol. 22, № 3. – P. 367–378. doi: 10.1007/s40257-021-00592-w

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63. Patil, S. Musculoskeletal sarcoidosis: ф single center experience over 15 years / S. Patil [et al.] // Int. J. Rheum. Dis. – 2021. – Vol. 24, № 4. – P. 533–541. doi: 10.1111/1756-185X.14068

64. Agarwal, V. Arthritis in sarcoidosis: a multicentric study from India / V. Agarwal [et al.] // Int. J. Rheum. Dis. – 2018. – Vol. 21, № 9. – P. 1728–1733. doi: 10.1111/1756185X.13349

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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

78. Chuchalin, A. G. Sarkoidoz: federal’nye klinicheskie rekomendacii po diagnostike i lecheniju [Sarcoidosis: Federal Clinical Guidelines for Diagnosis and Treatment] / G. Chuchalin [i dr.] // Pul’monologija. – 2022. – № 6. – S. 806–833. [in Russian]. doi: 10.18093/0869-0189-2022-32-6-806-833

79. Govender, P. The diagnosis of sarcoidosis / P. Govender, J. S. Berman // Clin. Chest Med. – 2015. – Vol. 36, № 4. – P. 585–602. doi: 10.1016/j.ccm.2015. 08.003

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