There are multiple patterns of bone involvement in osseous sarcoidosis, ranging from large cystic lesions that can lead to stress fractures to “tunnels” or “lace-like” reticulated patterns found in the bones of the hands and feet. 2,3,5,6 Long bone involvement is typically limited to the proximal and distal thirds of the bone.6 Sarcoidosis is also known to involve the axial skeleton, and less commonly, the cranial vault.6 Although multiple variations may manifest over time, skin changes usually precede bone lesions3,6; however, that was not the case with this patient.
Treatment entails pain management
Up to 50% of patients with bone lesions are symptomatic and may require treatment.3,5 Treatment is reserved for these symptomatic patients, with the goal of pain reduction.2,3,7
Low- to moderate-dose corticosteroids have been shown to relieve soft-tissue swelling and decrease pain.2,3,7 A prolonged course of steroids is not recommended, due to the risk of osteoporosis and fractures, and does not normalize bone structure.3,7
Other options. NSAIDs, such as colchicine and indomethacin, have also been found to be effective in pain management.7 Treatments such as methotrexate and hydroxychloroquine may be considered for those cases that are refractory to steroids.2
Given the extent of our patient’s disease, he was referred to multiple specialists to rule out further organ involvement. He was found to have neurosarcoidosis on brain imaging and was subsequently treated with prednisone 10 mg/d. The patient is being routinely monitored for active disease at various intervals or as symptoms arise.
THE TAKEAWAY
Consideration for systemic diseases (eg, sarcoidosis) should be given to patients presenting with musculoskeletal complaints without a significant history of trauma or injury. In those with risk factors associated with a higher incidence of sarcoidosis, such as age and race, a work-up should include imaging and biopsy. Treatment (eg, corticosteroids, NSAIDs) is provided to those patients who are symptomatic, with the goal of symptom relief.3