BONE Sarcoidosis: A French Case Control Study

Imen Ben hassine¹, Christopher Rein², Cloé Comarmond³, Catherine Chapelon-Abric⁴, Nathalie Saidenberg⁵, Benoit Meunier⁶, Nicolas Schleinitz⁷, Noémie Chanson⁸, Marc Scherlinger⁹, Christophe Richez¹⁰, Sandrine Hirschi¹¹, Matthieu Groh¹², Hervé Devilliers¹³, David Saadoun¹⁴, Laurent Arnaud¹⁵ and Patrice Cacoub¹⁶, ¹Internal Medicine and Clinical Immunology, Pitié-Salpêtrière Hospital, Paris, France, ²Rheumatology, UPMC GRC08, Paris 06 University, Pitié Salpétrière Hospital, Paris, France, ³DHU 2iB Internal Medicine Referal Center for Autoimmune diseases Pitie Hospital, Paris, France, ⁴AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Department of Internal Medicine and Clinical Immunology, F-75013, Paris, France, Paris, France, ⁵Rheumatology, CHU Avicennes, Bobigny, France, ⁶Internal Medicine, CHU La Timone, Marseille, France, ⁷La Timone University Hospital, Marseille, France, ⁸Internal Medicine, Hopital Bicetre, LE KREMLIN BICETRE, France, ⁹Rheumatology, UMR CNRS 5164 - Immunoconcept, France, Bordeaux, France, ¹⁰UMR CNRS 5164 - Immunoconcept, Bordeaux, France, ¹¹Pneumology, CHU de Strasbourg, Strasbourg, France, ¹²Internal Medicine, Foch, Suresnes, France, ¹³Service de Médecine Interne et Maladies Systémiques, CHU de Dijon, Dijon, France, ¹⁴Sorbonne Universités, UPMC Univ Paris 06, UMR 7211, and Inflammation-Immunopathology-Biotherapy Department (DHU i2B), F-75005, Paris, France; INSERM, UMR_S 959, F-75013, Paris, France; CNRS, FRE3632, F-75005, Paris, France; AP-HP, Groupe Hospitalier Pitié, Paris, France, ¹⁵Department of Medicine, Rheumatology Unit, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden, ¹⁶Department of Internal Medicine and Clinical Immunology, Groupe Hospitalier Pitié-Salpêtrière, Paris, France

Meeting: 2018 ACR/ARHP Annual Meeting

Keywords: Bone and sarcoidosis

Session Information

Date: Tuesday, October 23, 2018

Title: Miscellaneous Rheumatic and Inflammatory Diseases Poster III: Sarcoid, Inflammatory Eye Disease, and Autoinflammatory Disease

Session Type: ACR Poster Session C

Session Time: 9:00AM-11:00AM

Background/Purpose:

Osseous manifestations of sarcoidosis are uncommon. We aimed to characterize clinical presentation, distribution of lesions, treatment, and outcomes of bone sarcoidosis.

Methods:

A French retrospective multicenter study of patients with biopsy-proven sarcoidosis and osseous manifestations was analyzed. Inclusion criteria for sarcoidosis with bone involvement were 1) a biopsy-proven granuloma without caseous necrosis and either 2) bone clinical manifestations or 3) abnormal bone imaging. Musculo-squeletal involvement with isolated joint or muscular manifestations were excluded. Sarcoidosis patients with bone involvement (patients) were compared to 264 age- and sex-matched patients with a biopsy-proven sarcoidosis and no bone manifestations (controls).

Results:

In bone sarcoidosis group (n=88), the median age [IQR] at sarcoidosis diagnosis was 41 [34-51] years, and 44 (50%) patients were women. Forty two out of 88 (48%) patients had bone related symptoms, involving mainly axial (69%) and/or appendicular (58%) skeleton. On imaging, spine was the most commonly affected bone (52%), followed by pelvis (42%), hands (22%) and femur (19%). Bone biopsy showed granuloma without caseous necrosis in 17/25 (68%) patients. Compared to controls, bone sarcoidosis patients had higher rates of mediastinal (93% vs 47%, P < 0.0001) and extra-thoracic lymph node (66% vs 21%, P < 0.0001), and pulmonary (90% vs 65%, P < 0.0001) and cutaneous involvement (44% vs 23%, P < 0.0001). Gastro-intestinal involvement was less frequent in bone sarcoidosis group (1% vs 17%, P < 0.0001). Hypercalcemia was observed in 8.5% of patients compared to 2% of controls (P=0.014). Seven patients did not receive specific treatment for bone sarcoidosis. Glucocorticoid was used in 63/81 (78%) patients, alone in 44 patients, and associated with methotrexate in 13 patients or hydroxychloroquine in 6 patients. Rates of clinical and/or radiological response of bone sarcoidosis were 23/44 (52%), 9/13 (70%) and 4/6 (67%), respectively.

Conclusion:

In patients with bone sarcoidosis, spine and pelvis were the most commonly affected bones. Patients with bone sarcoidosis compared to sarcoidosis patients with no bone involvement have higher rates of thoracic and extra-thoracic lymph node, pulmonary, cutaneous involvement and hypercalcemia. Most patients with bone sarcoidosis had a good response to glucocorticoids used alone or in association with methotrexate or hydroxychloroquine.

Disclosure: I. Ben hassine, None; C. Rein, None; C. Comarmond, None; C. Chapelon-Abric, None; N. Saidenberg, None; B. Meunier, None; N. Schleinitz, None; N. Chanson, None; M. Scherlinger, None; C. Richez, None; S. Hirschi, None; M. Groh, None; H. Devilliers, None; D. Saadoun, None; L. Arnaud, None; P. Cacoub, None.

To cite this abstract in AMA style:

Ben hassine I, Rein C, Comarmond C, Chapelon-Abric C, Saidenberg N, Meunier B, Schleinitz N, Chanson N, Scherlinger M, Richez C, Hirschi S, Groh M, Devilliers H, Saadoun D, Arnaud L, Cacoub P. BONE Sarcoidosis: A French Case Control Study [abstract]. Arthritis Rheumatol. 2018; 70 (suppl 9). https://acrabstracts.org/abstract/bone-sarcoidosis-a-french-case-control-study/. Accessed .

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