Musculoskeletal Sarcoidosis: Characterization and Clinical Expression of 129 Patients with Granulomatous Infiltration of Bones And/or Muscles

Soledad Retamozo¹, Roberto Pérez-Alvarez ², Esperanza Bueno Juana ³, Carlos Feijoo-Massó ⁴, Andrés González-García ⁵, Joel Chara-Cervantes ⁶, Carmen Yllera Gutiérrez ⁷, Miguel López Dupla ⁸, Ana Alguacil ⁹, Javier Rascón ¹⁰, Mercedes Pérez-Conesa ⁶, Mariona Bonet ¹¹, Angel Robles ¹², José Luis Callejas ¹³, Neera Toledo Samaniego ¹⁴, Eva Fonseca Aizpuru ¹⁵, Patricia Perez Guerrero ¹⁶, Jose Salvador Garcia Morillo ¹⁷, Borja de Miguel ¹⁸, Miriam Akasbi ¹⁹, Rosa Tejera Pérez ²⁰, Gloria De La Red Bellvis ²¹, Eva Calvo Begueria ²², Jorge Francisco Gómez Cerezo ²³, Albert Gómez Lozano ²⁴, Enrique Peral Gutiérrez De Ceballos ²⁵, Gracia Cruz-Caparrós ²⁶, Sergio Rodríguez Fernández ²⁷, Alberto Gato Diez ²⁸, César Morcillo ²⁹, Inmaculada Ojeda ³⁰, M José Vives ³¹, María Penadés Vidal ³², Moisés De Vicente ³³, Belchin Kostov ³⁴, Lucio Pallarés ¹⁰, Pilar Brito-Zerón ³⁵ and Manuel Ramos-Casals ³⁶, ¹Instituto De Investigaciones En Ciencias De La Salud, Univ. Nacional de Córdoba, Consejo Nacional de Investigaciones Científicas y Técnicas. Instituto Universitario de Ciencias Biomédicas de Córdoba, Córdoba, Argentina., Cordoba, Argentina, ²Department of Internal Medicine, Hospital Alvaro Cunqueiro, Vigo, Spain., Vigo, Spain, ³Hospital Clínico, Zaragoza, Spain, Zaragoza, Spain, ⁴Hospital Parc Tauli, Sabadell, Sabadell, Spain, ⁵Hospital Ramon y Cajal, Madrid, Spain, Madrid, Spain, ⁶Hospital Universitario Miguel Servet, Zaragoza, Spain, Zaragoza, Spain, ⁷Department of Internal Medicine, Hospital Universitario Central de Asturias, Oviedo, Spain, Oviedo, Spain, ⁸Systemic Autoimmune Diseases Unit, Hospital Joan XXIII, Tarragona, Spain., Tarragona, Spain, ⁹Hospital Virgen de la Salud, Toledo, Spain, Toledo, Spain, ¹⁰Hospital Son Espases, Palma de Mallorca, Spain, Palma de Mallorca, Spain, ¹¹Department of Internal Medicine, Althaia, Xarxa Assistencial de Manresa, Spain, Manresa, Spain, ¹²Hospital La Paz, Madrid, Spain, Madrid, Spain, ¹³Hospital Clínico San Cecilio, Granada, Spain, Granada, Spain, ¹⁴Systemic Autoimmune Diseases Unit Medicine, Hospital Gregorio Marañón, Madrid, Spain, Madrid, Spain, ¹⁵Department of Internal Medicine, Hospital de Cabueñes, Gijón, Spain, Gijón, Spain, ¹⁶Department of Internal Medicine, Hospital Universitario Puerta del Mar, Cádiz, Spain, Cadiz, Spain, ¹⁷Department of Internal Medicine, Hospital Virgen del Rocio, Sevilla, Spain, Sevilla, Spain, ¹⁸Hospital 12 de Octubre, Madrid, Spain, Madrid, Spain, ¹⁹Hospital Infanta Leonor, Madrid, Madrid, Spain, ²⁰Department of Internal Medicine, Hospital Clínico Universitario de Salamanca-IBSAL. Salamanca, Spain, Salamanca, Spain, ²¹Department of Internal Medicine, Hospital de Santa Coloma de Gramanet, Barcelona, Spain, Barcelona, Spain, ²²Hospital Universitario Puerta del Mar, Cádiz, Spain, Cadiz, Spain, ²³Hospital Infanta Sofía, Madrid, Spain, Madrid, Spain, ²⁴Hospital de Sta Caterina, Girona, Spain, Girona, Spain, ²⁵Department of Internal Medicine, Hospital Virgen Macarena, Sevilla, Spain, Sevilla, Spain, ²⁶Department of Internal Medicine, Hospital de Poniente El Ejido, Almería, Spain, Almeria, Spain, ²⁷Department of Internal Medicine, Hospital da Barbanza, A Coruña, Spain, A Coruña, Spain, ²⁸Department of Internal Medicine, Complejo Hospitalario Albacete, Spain, Albacete, Spain, ²⁹Systemic Autoimmune Diseases Unit, Hospital CIMA-Sanitas, Barcelona, Spain, Barcelona, Spain, ³⁰Department of Internal Medicine, Hospital Valle del Guadiato, Córdoba, Spain, Cordoba, Spain, ³¹Parc Sanitari San Joan de Déu, Sant Boi, Barcelona, Spain, Barcelona, Spain, ³²Department of Internal Medicine, Hospital De Manises, Valencia, Spain, Valencia, Spain, ³³Department of Internal Medicine, Hospital Nuestra Señora del Prado, Talavera, Spain, Talavera, Spain, ³⁴Primary Healthcare Transversal Research Group, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS). Primary Care Centre Les Corts, Consorci d’Atenció Primària de Salut Barcelona Esquerra (CAPSBE). Department of Statistics and Operations Research, Universitat Politècnica de Catalunya, Barcelona, Spain., Barcelona, Spain, ³⁵Sjögren Syndrome Research Group (AGAUR), Laboratory of Autoimmune Diseases Josep Font, IDIBAPS-CELLEX, Department of Autoimmune Diseases, ICMiD, University of Barcelona, Hospital Clínic. Autoimmune Diseases Unit, Department of Medicine, Hospital CIMA- Sanitas, Barcelona, Spain., Barcelona, Spain, ³⁶Department of Autoimmune Diseases, ICMiD. Sjögren Syndrome Research Group (AGAUR), Laboratory of Autoimmune Diseases Josep Font, IDIBAPS-CELLEX. Department of Medicine, University of Barcelona, Hospital Clínic, Barcelona, Spain., Barcelona, Spain

Meeting: 2019 ACR/ARP Annual Meeting

Keywords: Clinical and Musculoskeletal, sarcoidosis

Session Information

Date: Sunday, November 10, 2019

Session Title: 3S104: Miscellaneous Rheumatic & Inflammatory Disease I: Expanding the Spectrum of Clinical Features in Rheumatological Disorders (903–908)

Session Type: ACR Abstract Session

Session Time: 4:30PM-6:00PM

Background/Purpose: To analyze the prevalence and characteristics of musculoskeletal sarcoidosis in a large nationwide multicenter cohort.

Methods: In January 2016, the Autoimmune Diseases Study Group (GEAS-SEMI) created a national registry (SARCOGEAS) of patients with sarcoidosis. Sarcoidosis was diagnosed in agreement with the criteria proposed by the American Thoracic Society/European Respiratory Society/World Association of Sarcoidosis and Other Granulomatous Disorders (WASOG) 1999 statement on sarcoidosis. Musculoskeletal involvement was characterized according to the 2014 WASOG organ assessment instrument, which is defined as the direct infiltrative granulomatous involvement affecting joints, bones, tendons and/or muscles (demonstrated either by imaging techniques or biopsy).

Results: Among 1521 patients included in the Registry at May 31, 2019, there were 129 (8.5%) that fulfilled the WASOG criteria for musculoskeletal sarcoidosis (72 women and 53 men, mean age at diagnosis of 45.4 years): 108 (7.1%) presented with osseous involvement and 21 (1.4%) presented with muscular sarcoidosis. Among patients presenting with osseous sarcoidosis, 24 presented typical radiological features of osseous granulomatous infiltration, 6 presented dactylitis, 25 nodular tenosynovitis and 56 asymptomatic osseous involvement demonstrated by PET/MRI: Among patients with muscular sarcoidosis, 5 presented with asymptomatic muscular involvement demonstrated by PET/MRI, 2 with palpable muscle masses, and the remaining 14 with biological/histopathological evidence of muscular involvement. In comparison with patients without musculoskeletal infiltrative involvement, those presenting with musculoskeletal sarcoidosis were predominantly White patients (96% vs 89%, p=0.025), had more frequently an acute onset of the disease (28% vs 18%, p=0.02), a higher frequency of systemic sarcoidosis (defined as the involvement of at least 2 different extrathoracic organs, 82% vs 30%, p< 0.001), a higher frequency of skin involvement (60% vs 35%, p< 0.001) and a higher frequency of need for therapy (64% vs 48%, p=0.001), including both glucocorticosteroids (61% vs 48%, p=0.007) and immunosuppressive agents (16% vs 7%, p=0.003).

Conclusion: Sarcoid musculoskeletal infiltration affects around 9% of patients with sarcoidosis, in most cases presenting as asymptomatic bone/muscular involvement demonstrated by PET, MRI and/or biopsy. These patients present with a very active systemic phenotypic profile, especially including cutaneous features, and required a more intensive systemic therapeutic approach.

Disclosure: S. Retamozo, None; R. Pérez-Alvarez, None; E. Bueno Juana, None; C. Feijoo-Massó, None; A. González-García, None; J. Chara-Cervantes, None; C. Yllera Gutiérrez, None; M. López Dupla, None; A. Alguacil, None; J. Rascón, None; M. Pérez-Conesa, None; M. Bonet, None; A. Robles, None; J. Callejas, None; N. Toledo Samaniego, None; E. Fonseca Aizpuru, None; P. Perez Guerrero, None; J. Garcia Morillo, None; B. de Miguel, None; M. Akasbi, None; R. Tejera Pérez, None; G. De La Red Bellvis, None; E. Calvo Begueria, None; J. Gómez Cerezo, None; A. Gómez Lozano, None; E. Gutiérrez De Ceballos, None; G. Cruz-Caparrós, None; S. Rodríguez Fernández, None; A. Gato Diez, None; C. Morcillo, None; I. Ojeda, None; M. Vives, None; M. Penadés Vidal, None; M. De Vicente, None; B. Kostov, None; L. Pallarés, None; P. Brito-Zerón, None; M. Ramos-Casals, None.

To cite this abstract in AMA style:

Retamozo S, Pérez-Alvarez R, Bueno Juana E, Feijoo-Massó C, González-García A, Chara-Cervantes J, Yllera Gutiérrez C, López Dupla M, Alguacil A, Rascón J, Pérez-Conesa M, Bonet M, Robles A, Callejas J, Toledo Samaniego N, Fonseca Aizpuru E, Perez Guerrero P, Garcia Morillo J, de Miguel B, Akasbi M, Tejera Pérez R, De La Red Bellvis G, Calvo Begueria E, Gómez Cerezo J, Gómez Lozano A, Gutiérrez De Ceballos E, Cruz-Caparrós G, Rodríguez Fernández S, Gato Diez A, Morcillo C, Ojeda I, Vives M, Penadés Vidal M, De Vicente M, Kostov B, Pallarés L, Brito-Zerón P, Ramos-Casals M. Musculoskeletal Sarcoidosis: Characterization and Clinical Expression of 129 Patients with Granulomatous Infiltration of Bones And/or Muscles [abstract]. Arthritis Rheumatol. 2019; 71 (suppl 10). https://acrabstracts.org/abstract/musculoskeletal-sarcoidosis-characterization-and-clinical-expression-of-129-patients-with-granulomatous-infiltration-of-bones-and-or-muscles/. Accessed June 3, 2020.

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