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结节病的肌肉、骨骼和血管病变表现

Authors
Winston Sequeira, MD
Rohit Aggarwal, MD, MSc
Section Editor
Peter H Schur, MD
Deputy Editor
Paul L Romain, MD
Translators
张卓莉, 主任医师，教授

引言

结节病是一种病因不明的多系统病症，病理特征为受累器官中存在非干酪性肉芽肿(参见“结节病发病机制”)。结节病通常累及年轻成人，虽然任何器官均可能受累，但该病通常表现为下述3种异常中的1种或多种：

  • 双侧肺门淋巴结肿大
  • 肺浸润
  • 皮肤和/或眼部病变

肌肉骨骼病变不太常见。然而，急性结节病患者的关节表现可能具有临床意义[1]。总的来说，4%-38%的结节病患者存在1种或多种肌肉骨骼表现[2]。

结节病除了关节炎以外的骨骼、肌肉和血管表现将总结在此。结节病相关的一般问题及其发病机制将单独讨论。 (参见“肺结节病的临床表现与诊断”和“结节病发病机制”)

美国胸科协会(American Thoracic Society, ATS)针对结节病的声明，以及ATS的其他指南，均可通过访问ATS网站获取www.thoracic.org/statements。

                        

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Literature review current through: 2017-06 . | This topic last updated: 2015-09-22.
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References
Top
  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. Kurashima K, Shimizu H, Ogawa H, et al. MR and CT in the evaluation of sarcoid myopathy. J Comput Assist Tomogr 1991; 15:1004.
  13. Otake S, Banno T, Ohba S, et al. Muscular sarcoidosis: findings at MR imaging. Radiology 1990; 176:145.
  14. Otake S, Imagumbai N, Suzuki M, Ohba S. MR imaging of muscular sarcoidosis after steroid therapy. Eur Radiol 1998; 8:1651.
  15. Tews DS, Pongratz DE. Immunohistological analysis of sarcoid myopathy. J Neurol Neurosurg Psychiatry 1995; 59:322.
  16. 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.
  17. Prayson RA. Granulomatous myositis. Clinicopathologic study of 12 cases. Am J Clin Pathol 1999; 112:63.
  18. 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.
  19. Gemignani F, Bellanova MF, Salih S, et al. Sarcoid neuromyopathy with selective involvement of the intramuscular nerves. Acta Neuropathol 1998; 95:437.
  20. 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.
  21. Yamamoto T, Nagira K, Akisue T, et al. Aspiration biopsy of nodular sarcoidosis of the muscle. Diagn Cytopathol 2002; 26:109.
  22. 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.
  23. James DG, Neville E, Carstairs LS. Bone and joint sarcoidosis. Semin Arthritis Rheum 1976; 6:53.
  24. 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.
  25. Neville E, Carstairs LS, James DG. Sarcoidosis of bone. Q J Med 1977; 46:215.
  26. BERK RN, BROWER TD. VERTEBRAL SARCOIDOSIS. Radiology 1964; 82:660.
  27. Young DA, Laman ML. Radiodense skeletal lesions in Boeck's sarcoid. Am J Roentgenol Radium Ther Nucl Med 1972; 114:553.
  28. Rubin MM, Sanfilippo RJ, Pliskin A. Maxillary alveolar bone loss in a patient with sarcoidosis. J Oral Maxillofac Surg 1991; 49:1351.
  29. CURTIS GT. SARCOIDOSIS OF THE NASAL BONES. Br J Radiol 1964; 37:68.
  30. Rothschild BM, Pingitore C, Eaton M. Dactylitis: implications for clinical practice. Semin Arthritis Rheum 1998; 28:41.
  31. Blacksin MF, Acello AN, Kowalec J, Lyons MM. Osseous sarcoidosis of the foot: detection by MR imaging. AJR Am J Roentgenol 1994; 163:1444.
  32. Le Breton C, Ferroir JP, Cadranel J, et al. Case report 825. Leptomeningeal and spinal-pelvic osseous sarcoidosis. Skeletal Radiol 1994; 23:297.
  33. Posner MA, Melendez E, Steiner G. Solitary osseous sarcoidosis in a finger. J Hand Surg Am 1991; 16:827.
  34. De Bardt M, Grossin M, Smadja M, Kahn MF. Vertebral osteosclerotic sarcoidosis. AJR Am J Roentgenol 1991; 157:1356.
  35. Vinnicombe S, Heron C, Wansbrough-Jones M. Dense bones. Br J Radiol 1992; 65:1049.
  36. Shaikh S, Soubani AO, Rumore P, et al. Lytic osseous destruction in vertebral sarcoidosis. N Y State J Med 1992; 92:213.
  37. Cutler SS, Sankaranarayanan G. Vertebral sarcoidosis. JAMA 1978; 240:557.
  38. Sundaram M, Place H, Shaffer WO, Martin DS. Progressive destructive vertebral sarcoid leading to surgical fusion. Skeletal Radiol 1999; 28:717.
  39. 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.
  40. Talmi D, Smith S, Mulligan ME. Central skeletal sarcoidosis mimicking metastatic disease. Skeletal Radiol 2008; 37:757.
  41. Nijjar SS, Leslie WD. A case of skeletal sarcoidosis imitating skeletal metastases on bone scintigraphy. CMAJ 2008; 178:153.
  42. Ginsberg LE, Williams DW 3rd, Stanton C. MRI of vertebral sarcoidosis. J Comput Assist Tomogr 1993; 17:158.
  43. Kenney CM 3rd, Goldstein SJ. MRI of sarcoid spondylodiskitis. J Comput Assist Tomogr 1992; 16:660.
  44. Perlman SG, Damergis J, Witorsch P, et al. Vertebral sarcoidosis with paravertebral ossification. Arthritis Rheum 1978; 21:271.
  45. 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.
  46. Erb N, Cushley MJ, Kassimos DG, et al. An assessment of back pain and the prevalence of sacroiliitis in sarcoidosis. Chest 2005; 127:192.
  47. Montemurro L, Fraioli P, Rizzato G. Bone loss in untreated longstanding sarcoidosis. Sarcoidosis 1991; 8:29.
  48. Fallon MD, Perry HM 3rd, Teitelbaum SL. Skeletal sarcoidosis with osteopenia. Metab Bone Dis Relat Res 1981; 3:171.
  49. 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.
  50. 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.
  51. Rizzato G, Fraioli P. Natural and corticosteroid-induced osteoporosis in sarcoidosis: prevention, treatment, follow up and reversibility. Sarcoidosis 1990; 7:89.
  52. 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.
  53. 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.
  54. Fernandes SR, Singsen BH, Hoffman GS. Sarcoidosis and systemic vasculitis. Semin Arthritis Rheum 2000; 30:33.
  55. Kwong T, Valderrama E, Paley C, Ilowite N. Systemic necrotizing vasculitis associated with childhood sarcoidosis. Semin Arthritis Rheum 1994; 23:388.
  56. DeRemee RA. Sarcoidosis and Wegener's granulomatosis: a comparative analysis. Sarcoidosis 1994; 11:7.
  57. Tariq S, McConnochie K, Mahy NJ, Williams WJ. Silent sarcoidosis and clubbing. Sarcoidosis 1990; 7:67.
  58. Yancey J, Luxford W, Sharma OP. Clubbing of the fingers in sarcoidosis. JAMA 1972; 222:582.
  59. Hashmi S, Kaplan D. Asymmetric clubbing as a manifestation of sarcoid bone disease. Am J Med 1992; 93:471.
  60. Alloway JA, Nashel DJ, Rohatgi PK. Sarcoidosis and hypertrophic osteoarthropathy. J Rheumatol 1992; 19:180.
  61. Wakelin SH, James MP. Sarcoidosis: nail dystrophy without underlying bone changes. Cutis 1995; 55:344.
  62. 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.
  63. Akama H, Yoshida T, Kawai S. Primary biliary cirrhosis coexisting with sarcoidosis--or possibly Sjögren's syndrome? West J Med 1991; 154:352.
  64. 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.
  65. Hunter T, Arnott JE, McCarthy DS. Features of systemic lupus erythematosus and sarcoidosis occurring together. Arthritis Rheum 1980; 23:364.