Background/Purpose: Sarcoidosis is a systemic inflammatory disease characterized by the formation of non-caseating granulomas. Osseous involvement in sarcoidosis is a rare manifestation and has infrequently been reported. The distribution of lesions, clinical presentation, treatment strategies, and outcomes of patients with osseous sarcoidosis are unclear. We have reviewed our experience with osseous sarcoidosis to better characterize these clinical features.

Methods: Potential cases of osseous sarcoidosis seen at a large tertiary care academic hospital by the Division of Rheumatology, Immunology and Allergy and the Division of Pulmonary and Critical Care Medicine were identified through directed inquiry and electronic health record queries. Cases were defined as having pathologic evidence of non-caseating granulomas on bone biopsy or evidence of osseous lesions on imaging attributable to sarcoidosis by the radiologist, treating clinician, and reviewer. Characteristics of the clinical presentation, treatment, and outcomes were obtained from thorough medical record review.

Results: We identified 19 cases of osseous sarcoidosis (9 with biopsy-proven disease and 10 with diagnosis based on imaging and clinical presentation). Osseous lesions were detected by imaging during the initial presentation for sarcoidosis in 11 of 19 cases (58%). In those who had a prior established diagnosis of sarcoidosis, the mean duration of sarcoidosis before osseous detection by imaging was 4.8 years. The mean duration between detection of lesions on imaging and definitive clinical diagnosis in those who had a bone biopsy was 344 days. Other systemic features of sarcoidosis were present in 18 out of 19 cases (95%). Hilar lymphadenopathy was present in most cases (16 out of 19, 84%). Symptoms were present in 10 out of 19 cases (53%) and consisted mostly of low back pain, arthralgias/arthritis, and soft tissue swelling.  Lesions were detected by magnetic resonance imaging (13 cases) and positron emission tomography (8 cases). All patients had more than one bone involved. Most patients (89%) had axial involvement, primarily in the pelvis and lumbar spine, and required no specific treatment if lesions were discovered incidentally. A minority of cases (9/19, 47%) were treated specifically for osseous sarcoidosis, mostly with prednisone and hydroxychloroquine. Two cases required multiple medications, including anti-tumor necrosis factor therapy, for refractory symptomatic osseous sarcoidosis. At last follow-up, 16 out of 19 (84%) patients were asymptomatic from osseous lesions.

Conclusion: We have identified the largest series of osseous sarcoidosis and characterized its clinical presentation, treatment, and outcomes. Patients with osseous sarcoidosis had multiple bones affected and generally had other systemic manifestations of sarcoidosis. A minority of patients required treatment of their osseous sarcoidosis for relief of symptoms and most patients were symptom-free at last follow-up.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/osseous-sarcoidosis-clinical-presentation-treatment-and-outcomes-experience-from-a-large-tertiary-care-academic-hospital/