Osseous sarcoidosis

» Most patients with osseous sarcoidosis present in their early forties, with a higher proportion being African-American. Typical clinical presentation is characterized by localized pain and swelling, most commonly in the vertebrae and the small bones of the hands and feet; the most common associated extraosseous symptoms are lymphadenopathy and pulmonary involvement. » Biopsies are mandatory for confirming a diagnosis of osseous sarcoidosis, but imaging modalities may be useful adjuncts. Radiographs may show lytic, sclerotic, or mixed patterns, and magnetic resonance imaging (MRI) studies may reveal typical T1 and T2 findings useful for monitoring lesion regression. Laboratory studies used in diagnosing or following extraosseous manifestations of sarcoidosis are not reliable for osseous sarcoidosis. » Corticosteroids are the first line of treatment for symptomatic, nonstructural osseous sarcoidosis. For refractory cases, adjuvant therapies may need to be added, including immunomodulators (methotrexate or tumor necrosis factor [TNF] alpha inhibitors) and nonsteroidal anti-inflammatory drugs (NSAIDs). Indications for operative intervention include irreversible bone pain, hypercalcemia, and radiographic evidence of severe cortical destruction. » For patients with isolated osseous lesions without a prior diagnosis of sarcoidosis, the orthopaedic surgeon should perform a thorough evaluation for extraosseous manifestations of sarcoidosis through a multimodal approach and should recommend vigilant follow-up.