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Sarcoid: Muscle, bone, and vascular disease manifestations

Winston Sequeira, MD
Rohit Aggarwal, MD, MSc
Section Editor
Peter H Schur, MD
Deputy Editor
Paul L Romain, MD


Sarcoidosis, a multisystem disorder of unknown etiology, is characterized pathologically by the presence of noncaseating granulomas in affected organs (see "Pathology and pathogenesis of sarcoidosis"). It typically affects young adults, and, although any organ may be affected, the disorder commonly presents with one or more of the following three abnormalities:

Bilateral hilar adenopathy

Pulmonary infiltrates

Skin and/or eye lesions

Musculoskeletal disease is a less common problem. However, joint manifestations may be clinically significant in patients with acute disease [1]. Overall, 4 to 38 percent of patients with sarcoidosis have one or more musculoskeletal manifestations [2].

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Literature review current through: Oct 2017. | This topic last updated: Sep 09, 2017.
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  1. Spilberg I, Siltzbach LE, McEwen C. The arthritis of sarcoidosis. Arthritis Rheum 1969; 12:126.
  2. Abril A, Cohen MD. Rheumatologic manifestations of sarcoidosis. Curr Opin Rheumatol 2004; 16:51.
  3. Baydur A, Pandya K, Sharma OP, et al. Control of ventilation, respiratory muscle strength, and granulomatous involvement of skeletal muscle in patients with sarcoidosis. Chest 1993; 103:396.
  4. Zisman DA, Biermann JS, Martinez FJ, et al. Sarcoidosis presenting as a tumorlike muscular lesion. Case report and review of the literature. Medicine (Baltimore) 1999; 78:112.
  5. Fayad F, Lioté F, Berenbaum F, et al. Muscle involvement in sarcoidosis: a retrospective and followup studies. J Rheumatol 2006; 33:98.
  6. Dewberry RG, Schneider BF, Cale WF, Phillips LH 2nd. Sarcoid myopathy presenting with diaphragm weakness. Muscle Nerve 1993; 16:832.
  7. Cornblath WT, Elner V, Rolfe M. Extraocular muscle involvement in sarcoidosis. Ophthalmology 1993; 100:501.
  8. Janssen M, Dijkmans BA, Eulderink F. Muscle cramps in the calf as presenting symptom of sarcoidosis. Ann Rheum Dis 1991; 50:51.
  9. Simmonds NJ, Hoffbrand BI. Contracturing granulomatous myositis: a separate entity. J Neurol Neurosurg Psychiatry 1990; 53:998.
  10. Gdynia HJ, Osterfeld N, Dorst J, et al. Granulomatous myositis mimicking slowly progressive lower motor neuron disease. Eur J Med Res 2008; 13:330.
  11. Mathur A, Kremer JM. Immunopathology, musculoskeletal features, and treatment of sarcoidosis. Curr Opin Rheumatol 1993; 5:90.
  12. Maeshima S, Koike H, Noda S, et al. Clinicopathological features of sarcoidosis manifesting as generalized chronic myopathy. J Neurol 2015; 262:1035.
  13. Pfeffer G, Povitz M, Gibson GJ, Chinnery PF. Diagnosis of muscle diseases presenting with early respiratory failure. J Neurol 2015; 262:1101.
  14. Prayson RA. Granulomatous myositis. Clinicopathologic study of 12 cases. Am J Clin Pathol 1999; 112:63.
  15. Larue S, Maisonobe T, Benveniste O, et al. Distal muscle involvement in granulomatous myositis can mimic inclusion body myositis. J Neurol Neurosurg Psychiatry 2011; 82:674.
  16. Kurashima K, Shimizu H, Ogawa H, et al. MR and CT in the evaluation of sarcoid myopathy. J Comput Assist Tomogr 1991; 15:1004.
  17. Otake S, Banno T, Ohba S, et al. Muscular sarcoidosis: findings at MR imaging. Radiology 1990; 176:145.
  18. Otake S, Imagumbai N, Suzuki M, Ohba S. MR imaging of muscular sarcoidosis after steroid therapy. Eur Radiol 1998; 8:1651.
  19. Marie I, Josse S, Lahaxe L, et al. Clinical images: Muscle sarcoidosis demonstrated on positron emission tomography. Arthritis Rheum 2009; 60:2847.
  20. Wieërs G, Lhommel R, Lecouvet F, et al. A tiger man. Lancet 2012; 380:1859.
  21. Kolilekas L, Triantafillidou C, Manali E, et al. The many faces of sarcoidosis: asymptomatic muscle mass mimicking giant-cell tumor. Rheumatol Int 2009; 29:1389.
  22. Tews DS, Pongratz DE. Immunohistological analysis of sarcoid myopathy. J Neurol Neurosurg Psychiatry 1995; 59:322.
  23. Takanashi T, Suzuki Y, Yoshino Y, Nonaka I. Granulomatous myositis: pathologic re-evaluation by immunohistochemical analysis of infiltrating mononuclear cells. J Neurol Sci 1997; 145:41.
  24. Kumamoto T, Yukishige K, Ito T, et al. Cellular distribution of proteolytic enzymes in the skeletal muscle of sarcoid myopathy. Acta Neuropathol 2002; 104:38.
  25. Gemignani F, Bellanova MF, Salih S, et al. Sarcoid neuromyopathy with selective involvement of the intramuscular nerves. Acta Neuropathol 1998; 95:437.
  26. Guo M, Lemos L, Baliga M. Nodular sarcoid myositis of skeletal muscle diagnosed by fine needle aspiration biopsy. A case report. Acta Cytol 1999; 43:1171.
  27. Yamamoto T, Nagira K, Akisue T, et al. Aspiration biopsy of nodular sarcoidosis of the muscle. Diagn Cytopathol 2002; 26:109.
  28. Kabitz HJ, Lang F, Walterspacher S, et al. Impact of impaired inspiratory muscle strength on dyspnea and walking capacity in sarcoidosis. Chest 2006; 130:1496.
  29. James DG, Neville E, Carstairs LS. Bone and joint sarcoidosis. Semin Arthritis Rheum 1976; 6:53.
  30. Chang JC, Sakurai H, Jagirdar J. Symptomatic rib lesions as the primary presentation of sarcoidosis. Report of two cases and review of literature. Sarcoidosis 1992; 9:130.
  31. Neville E, Carstairs LS, James DG. Sarcoidosis of bone. Q J Med 1977; 46:215.
  32. BERK RN, BROWER TD. VERTEBRAL SARCOIDOSIS. Radiology 1964; 82:660.
  33. Young DA, Laman ML. Radiodense skeletal lesions in Boeck's sarcoid. Am J Roentgenol Radium Ther Nucl Med 1972; 114:553.
  34. Rubin MM, Sanfilippo RJ, Pliskin A. Maxillary alveolar bone loss in a patient with sarcoidosis. J Oral Maxillofac Surg 1991; 49:1351.
  36. Rothschild BM, Pingitore C, Eaton M. Dactylitis: implications for clinical practice. Semin Arthritis Rheum 1998; 28:41.
  37. Blacksin MF, Acello AN, Kowalec J, Lyons MM. Osseous sarcoidosis of the foot: detection by MR imaging. AJR Am J Roentgenol 1994; 163:1444.
  38. Le Breton C, Ferroir JP, Cadranel J, et al. Case report 825. Leptomeningeal and spinal-pelvic osseous sarcoidosis. Skeletal Radiol 1994; 23:297.
  39. Posner MA, Melendez E, Steiner G. Solitary osseous sarcoidosis in a finger. J Hand Surg Am 1991; 16:827.
  40. De Bardt M, Grossin M, Smadja M, Kahn MF. Vertebral osteosclerotic sarcoidosis. AJR Am J Roentgenol 1991; 157:1356.
  41. Vinnicombe S, Heron C, Wansbrough-Jones M. Dense bones. Br J Radiol 1992; 65:1049.
  42. Shaikh S, Soubani AO, Rumore P, et al. Lytic osseous destruction in vertebral sarcoidosis. N Y State J Med 1992; 92:213.
  43. Cutler SS, Sankaranarayanan G. Vertebral sarcoidosis. JAMA 1978; 240:557.
  44. Sundaram M, Place H, Shaffer WO, Martin DS. Progressive destructive vertebral sarcoid leading to surgical fusion. Skeletal Radiol 1999; 28:717.
  45. Clarençon F, Silbermann-Hoffman O, Lebreton C, et al. Diffuse spine involvement in sarcoidosis with sternal lytic lesions: two case reports. Spine (Phila Pa 1976) 2007; 32:E594.
  46. Talmi D, Smith S, Mulligan ME. Central skeletal sarcoidosis mimicking metastatic disease. Skeletal Radiol 2008; 37:757.
  47. Nijjar SS, Leslie WD. A case of skeletal sarcoidosis imitating skeletal metastases on bone scintigraphy. CMAJ 2008; 178:153.
  48. Ginsberg LE, Williams DW 3rd, Stanton C. MRI of vertebral sarcoidosis. J Comput Assist Tomogr 1993; 17:158.
  49. Kenney CM 3rd, Goldstein SJ. MRI of sarcoid spondylodiskitis. J Comput Assist Tomogr 1992; 16:660.
  50. Perlman SG, Damergis J, Witorsch P, et al. Vertebral sarcoidosis with paravertebral ossification. Arthritis Rheum 1978; 21:271.
  51. Franco M, Passeron C, Tieulie N, et al. Long-term radiographic follow-up in a patient with osteosclerotic sarcoidosis of the spine and pelvis. Rev Rhum Engl Ed 1998; 65:586.
  52. Erb N, Cushley MJ, Kassimos DG, et al. An assessment of back pain and the prevalence of sacroiliitis in sarcoidosis. Chest 2005; 127:192.
  53. Montemurro L, Fraioli P, Rizzato G. Bone loss in untreated longstanding sarcoidosis. Sarcoidosis 1991; 8:29.
  54. Fallon MD, Perry HM 3rd, Teitelbaum SL. Skeletal sarcoidosis with osteopenia. Metab Bone Dis Relat Res 1981; 3:171.
  55. Reichel H, Koeffler HP, Norman AW. The role of the vitamin D endocrine system in health and disease. N Engl J Med 1989; 320:980.
  56. Montemurro L, Fraioli P, Riboldi A, et al. Bone loss in prednisone treated sarcoidosis: a two-year follow-up. Ann Ital Med Int 1990; 5:164.
  57. Rizzato G, Fraioli P. Natural and corticosteroid-induced osteoporosis in sarcoidosis: prevention, treatment, follow up and reversibility. Sarcoidosis 1990; 7:89.
  58. Montemurro L, Schiraldi G, Fraioli P, et al. Prevention of corticosteroid-induced osteoporosis with salmon calcitonin in sarcoid patients. Calcif Tissue Int 1991; 49:71.
  59. Gallacher SJ, Fenner JA, Anderson K, et al. Intravenous pamidronate in the treatment of osteoporosis associated with corticosteroid dependent lung disease: an open pilot study. Thorax 1992; 47:932.
  60. Fernandes SR, Singsen BH, Hoffman GS. Sarcoidosis and systemic vasculitis. Semin Arthritis Rheum 2000; 30:33.
  61. Kwong T, Valderrama E, Paley C, Ilowite N. Systemic necrotizing vasculitis associated with childhood sarcoidosis. Semin Arthritis Rheum 1994; 23:388.
  62. Rosé CD, Wouters CH, Meiorin S, et al. Pediatric granulomatous arthritis: an international registry. Arthritis Rheum 2006; 54:3337.
  63. Caso F, Costa L, Rigante D, et al. Caveats and truths in genetic, clinical, autoimmune and autoinflammatory issues in Blau syndrome and early onset sarcoidosis. Autoimmun Rev 2014; 13:1220.
  64. Weiler V, Redtenbacher S, Bancher C, et al. Concurrence of sarcoidosis and aortitis: case report and review of the literature. Ann Rheum Dis 2000; 59:850.
  65. Kerr GS, Hallahan CW, Giordano J, et al. Takayasu arteritis. Ann Intern Med 1994; 120:919.
  66. DeRemee RA. Sarcoidosis and Wegener's granulomatosis: a comparative analysis. Sarcoidosis 1994; 11:7.
  67. Riono WP, Hidayat AA, Rao NA. Scleritis: a clinicopathologic study of 55 cases. Ophthalmology 1999; 106:1328.
  68. Hasni SA, Gruber BL. Sarcoidosis presenting as necrotizing sinus destruction mimicking Wegener's granulomatosis. J Rheumatol 2000; 27:512.
  69. Tami TA. Granulomatous diseases and chronic rhinosinusitis. Otolaryngol Clin North Am 2005; 38:1267.
  70. Westreich RW, Lawson W. Midline necrotizing nasal lesions: analysis of 18 cases emphasizing radiological and serological findings with algorithms for diagnosis and management. Am J Rhinol 2004; 18:209.
  71. Rocha N, Velho G, Rodrigues M, et al. Cutaneous sarcoid-like granulomas with alveolar hemorrhage and c-ANCA PR-3. Int J Dermatol 2004; 43:668.
  72. Ullrich S, Lamprecht P, Gross WL. Acute sarcoidosis subsequent to Wegener's granulomatosis: an unusual sequence of two granulomatous diseases. Sarcoidosis Vasc Diffuse Lung Dis 2002; 19:45.
  73. Kuttikat A, Saeed T, Chopra B, et al. Nasal Wegener's and skin sarcoid--a rare combination of two granulomatous diseases. Clin Rheumatol 2006; 25:895.
  74. Ahuja TS, Mattana J, Valderrama E, et al. Wegener's granulomatosis followed by development of sarcoidosis. Am J Kidney Dis 1996; 28:893.
  75. Kihiczak D, Nychay SG, Schwartz RA, et al. Protracted superficial Wegener's granulomatosis. J Am Acad Dermatol 1994; 30:863.
  76. Tariq S, McConnochie K, Mahy NJ, Williams WJ. Silent sarcoidosis and clubbing. Sarcoidosis 1990; 7:67.
  77. Yancey J, Luxford W, Sharma OP. Clubbing of the fingers in sarcoidosis. JAMA 1972; 222:582.
  78. Hashmi S, Kaplan D. Asymmetric clubbing as a manifestation of sarcoid bone disease. Am J Med 1992; 93:471.
  79. Alloway JA, Nashel DJ, Rohatgi PK. Sarcoidosis and hypertrophic osteoarthropathy. J Rheumatol 1992; 19:180.
  80. Wakelin SH, James MP. Sarcoidosis: nail dystrophy without underlying bone changes. Cutis 1995; 55:344.
  81. Needleman SW, Silber RA, Von Brecht JH, Goeken JA. Systemic lupus erythematosus complicated by disseminated sarcoidosis. Report of a case associated with circulating immune complexes. Am J Clin Pathol 1982; 78:105.
  82. Akama H, Yoshida T, Kawai S. Primary biliary cirrhosis coexisting with sarcoidosis--or possibly Sjögren's syndrome? West J Med 1991; 154:352.
  83. Andonopoulos AP, Papathanasopoulos PG, Karatza C, et al. Sarcoidosis in a patient with myasthenia gravis. Case report and review of the literature. Clin Rheumatol 1991; 10:323.
  84. Hunter T, Arnott JE, McCarthy DS. Features of systemic lupus erythematosus and sarcoidosis occurring together. Arthritis Rheum 1980; 23:364.