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Yeung T, Grebowicz A, Nevskaya T, Zahid S, Pope JE. Joint involvement in sarcoidosis: systematic review and meta-analysis of prevalence, clinical pattern and outcome. Rheumatology (Oxford) 2024; 63:1803-1814. [PMID: 38281070 DOI: 10.1093/rheumatology/keae048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Revised: 12/04/2023] [Accepted: 12/28/2023] [Indexed: 01/29/2024] Open
Abstract
OBJECTIVES To characterize joint involvement (JI) in sarcoidosis, a systematic search of MEDLINE, EMBASE and Cochrane Library was conducted from inception to July 2022 for publications reporting its prevalence, pattern, treatment and outcome. METHODS The pooled prevalence estimates (PPE) with 95% CI were calculated using binomial distribution and random effects. Meta-regression method was used to examine factors affecting heterogeneity between studies. RESULTS Forty-nine articles were identified comprising a total of 8574 sarcoidosis patients, where 12% presented with JI (95% CI 10, 14; I2 = 0%). The PPE for sarcoid arthritis (SA) was 19% (95% CI 14, 24; I2 = 95%), and 32% (95% CI 13, 51; I2 = 99%) for arthralgia. Heterogeneity was due to higher JI prevalence reported in Western Asia and the Middle East, in rheumatology clinics and via surveys. Sample size of SA varied from 12 to 117 cases. Ankles were most frequently affected (PPE 80%) followed by knees and wrists. Monoarthritis was uncommon (PPE 1%; 95% CI 0, 2; I2 = 55%). Acute SA prevailed (PPE 79%; 95% CI 72, 88; I2 = 69%) with an equal proportion of oligo and polyarthritis and was frequently accompanied by erythema nodosum (PPE 62%; 95% CI 52, 71; I2 = 16%). Chronic SA was predominantly polyarticular with a higher frequency of the upper extremity joints affected. Most common non-articular manifestations with SA included fever (52%), erythema nodosum (41%), hilar adenopathy (86%) and interstitial lung disease (23%) of which one-third required corticosteroids and/or immunosuppressants. CONCLUSION SA occurred early in the disease with a PPE of 19% and most frequent pattern of acute oligo- or polyarthritis predominantly affecting the lower extremity large joints.
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Affiliation(s)
- Terence Yeung
- Division of Rheumatology, Department of Medicine, Schulich School of Medicine, University of Western Ontario, London, ON, Canada
| | - Adrian Grebowicz
- Division of Rheumatology, Department of Medicine, Schulich School of Medicine, University of Western Ontario, London, ON, Canada
| | - Tatiana Nevskaya
- Division of Rheumatology, Department of Medicine, Schulich School of Medicine, University of Western Ontario, London, ON, Canada
| | - Sulman Zahid
- Division of Rheumatology, Department of Medicine, Schulich School of Medicine, University of Western Ontario, London, ON, Canada
| | - Janet E Pope
- Division of Rheumatology, Department of Medicine, Schulich School of Medicine, University of Western Ontario, London, ON, Canada
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Smedslund G, Kotar AM, Uhlig T. Sarcoidosis with musculoskeletal manifestations: systematic review of non-pharmacological and pharmacological treatments. Rheumatol Int 2022; 42:2109-2124. [PMID: 35943526 PMCID: PMC9548475 DOI: 10.1007/s00296-022-05171-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 07/04/2022] [Indexed: 11/29/2022]
Abstract
We aimed to summarise effects and use of non-pharmacological and pharmacological treatments for sarcoidosis with musculoskeletal manifestations. We systematically searched the Cochrane Library, Ovid MEDLINE, Embase, CINAHL, AMED, Scopus, clinical.trials.gov, PROSPERO and PEDro for systematic reviews from 2014 to 2022 and for primary studies from date of inception to March 29, 2022, and studies with patients diagnosed with sarcoidosis with musculoskeletal manifestations. Inclusion criteria required that studies reported effects of non-pharmacological and/or pharmacological treatments or number of patients receiving these treatments. Results were reported narratively and in forest plots. Eleven studies were included. No systematic reviews fulfilled our inclusion criteria. None of the included studies had a control group. We found that between 23 and 100% received corticosteroids, 0-100% received NSAIDs, 5-100% received hydroxychloroquine, 12-100% received methotrexate, 0-100% received TNF inhibitors, and 3-4% received azathioprine. Only ten patients in one study had used non-pharmacological treatments, including occupational therapy, chiropractic and acupuncture. There are no controlled studies on treatment effects for patients with sarcoidosis with musculoskeletal manifestations. We found 11 studies reporting use of pharmacological treatments and only one study reporting use of non-pharmacological treatments. Our study identified major research gaps for pharmacological and non-pharmacological treatment in musculoskeletal sarcoidosis and warrant randomised clinical trials for both.
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Affiliation(s)
- Geir Smedslund
- Division of Rheumatology and Research, Diakonhjemmet Hospital, Norwegian National Advisory Unit On Rehabilitation in Rheumatology, Oslo, Norway.
| | - Annie Martina Kotar
- Division of Rheumatology and Research, Diakonhjemmet Hospital, Norwegian National Advisory Unit On Rehabilitation in Rheumatology, Oslo, Norway
| | - Till Uhlig
- Division of Rheumatology and Research, Diakonhjemmet Hospital, Norwegian National Advisory Unit On Rehabilitation in Rheumatology, Oslo, Norway
- University of Oslo, Oslo, Norway
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Hasbani GE, Uthman I, Jawad AS. Musculoskeletal Manifestations of Sarcoidosis. CLINICAL MEDICINE INSIGHTS. ARTHRITIS AND MUSCULOSKELETAL DISORDERS 2022; 15:11795441211072475. [PMID: 35185345 PMCID: PMC8854226 DOI: 10.1177/11795441211072475] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Accepted: 12/09/2021] [Indexed: 01/12/2023]
Abstract
Since its initial description in the late 19th century, sarcoidosis has been extensively studied. Although the general mechanism of immune activation is known, many details especially in the context of disease associations are still missing. One of such associations is the musculoskeletal complications that are widely variable in terms of presentation and response to treatment. Sarcoidosis can involve the joints leading to acute and, less commonly chronic, arthritis. While acute arthritis is mostly self-resolving in nature, chronic arthritis may lead to deformity and destruction of the joint. Sarcoidosis can also involve the muscles, leading to different pathologies primarily categorized according to the clinical presentation, despite the efforts to find a new classification based on imaging, histological, and clinical findings. The bones can be directly and indirectly affected. Different types of bone lesions have been described, although around half of these patients remain asymptomatic. Osteoporosis, increased risk of fractures, hypercalcemia, and hypercalciuria are examples of the indirect effect of sarcoidosis on the bones, possibly contributed to elevated levels of calcitriol. Nevertheless, sarcoidosis can be associated with small-vessel, medium-vessel, and large vessel vasculitis, although it is frequently difficult to differentiate between the co-existence of a pure vasculitis and sarcoidosis and sarcoid vasculitis.
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Affiliation(s)
- Georges El Hasbani
- Department of Internal Medicine, St. Vincent's Medical Center, Bridgeport, CT, USA
| | - Imad Uthman
- Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Ali Sm Jawad
- Department of Rheumatology, The Royal London Hospital, London, UK
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Obi ON, Lower EE, Baughman RP. Biologic and advanced immunomodulating therapeutic options for sarcoidosis: a clinical update. Expert Rev Clin Pharmacol 2021; 14:179-210. [PMID: 33487042 DOI: 10.1080/17512433.2021.1878024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Introduction: Sarcoidosis is a multi-organ disease with a wide range of clinical manifestations and outcomes. A quarter of sarcoidosis patients require long-term treatment for chronic disease. In this group, corticosteroids and cytotoxic agents be insufficient to control diseaseAreas covered: Several biologic agents have been studied for treatment of chronic pulmonary and extra-pulmonary disease. A review of the available literature was performed searching PubMed and an expert opinion regarding specific therapy was developed.Expert opinion: These agents have the potential of treating patients who have progressive disease. Many of these agents have different mechanisms of action, response rates, and toxicity profiles.
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Affiliation(s)
- Ogugua Ndili Obi
- Division of Pulmonary Critical Care and Sleep Medicine, Brody School of Medicine, East Carolina University, Greenville, NC, USA
| | - Elyse E Lower
- Department of Medicine, University of Cincinnati, Cincinnati, Ohio, USA
| | - Robert P Baughman
- Department of Medicine, University of Cincinnati, Cincinnati, Ohio, USA
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Cacciatore C, Belnou P, Thietart S, Desthieux C, Versini M, Abisror N, Ottaviani S, Cormier G, Deroux A, Dellal A, Belhomme N, Kermanac'H NS, Khafagy P, Michaud M, Lanot S, Carrat F, Fain O, Mékinian A. Acute and Chronic Sarcoid Arthropathies: Characteristics and Treatments From a Retrospective Nationwide French Study. Front Med (Lausanne) 2020; 7:565420. [PMID: 33363181 PMCID: PMC7758528 DOI: 10.3389/fmed.2020.565420] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Accepted: 10/16/2020] [Indexed: 12/26/2022] Open
Abstract
Introduction: We aimed to analyze patients with acute and chronic joint involvements in sarcoidosis. Methods: This is a retrospective multicenter analysis of patients with proven sarcoidosis, as defined by clinical, radiological, and histological criteria, with at least one clinical and/or ultrasonographic synovitis. Results: Thirty-nine patients with sarcoid arthropathy were included, and among them 19 had acute sarcoidosis (Lofgren's syndrome). Joint involvement and DAS44-CRP were not significantly different in acute and chronic sarcoid arthropathies. Acute forms were more frequent than chronic sarcoid arthropathy in Caucasians, without any difference of sex or age between these 2 forms. Joint involvement was frequently more symmetrical in acute than chronic forms (100 vs. 70%; p < 0.05), with a more frequent involvement in wrists and ankles in acute forms, whereas the tender and swollen joint counts and the DAS44-CRP were similar between the 2 groups. Skin lesions were significantly more frequent in patients with acute forms [17 (89%) vs. 5 (25%); p < 0.05] and were erythema nodosum in all patients with Löfgren's syndrome and sarcoid skin lesions in those with chronic sarcoidosis. Among 20 patients with chronic sarcoidosis, treatment was used in 17 (85%) cases, and consisted in NSAIDs alone (n = 5; 25%), steroids alone (n = 5; 25%), hydroxychloroquine (n = 2; 20%), methotrexate (n = 3; 15%), and TNF inhibitors (n = 2; 10%). A complete/partial joint response was noted in 14 (70%) cases with a DAS44-CRP reduction of 2.07 [1.85–2.44] (from 3.13 [2.76–3.42] to 1.06 [0.9–1.17]; p < 0.05). Conclusion: Sarcoid arthropathies have different clinical phenotypes in acute and chronic forms and various treatment regimens such as hydroxychloroquine and methotrexate could be used in chronic forms.
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Affiliation(s)
- Carlotta Cacciatore
- Sorbonne Université, Service de médecine interne, Hôpital Saint-Antoine, DHU I2B: Inflammation, Immunopathologie, Biothérapie, APHP, Paris, France
| | - Pierre Belnou
- Sorbonne Université, Service de santé publique, Hôpital Saint-Antoine, APHP, Paris, France
| | - Sara Thietart
- Sorbonne Université, Service de médecine interne, Hôpital Saint-Antoine, DHU I2B: Inflammation, Immunopathologie, Biothérapie, APHP, Paris, France
| | - Carole Desthieux
- Sorbonne Université, Service de médecine interne, Hôpital Saint-Antoine, DHU I2B: Inflammation, Immunopathologie, Biothérapie, APHP, Paris, France
| | - Mathilde Versini
- Service de Médecine interne, Centre Hospitalier Universitaire de Nice, Nice, France
| | - Noemie Abisror
- Sorbonne Université, Service de médecine interne, Hôpital Saint-Antoine, DHU I2B: Inflammation, Immunopathologie, Biothérapie, APHP, Paris, France
| | | | | | - Alban Deroux
- Service de médecine interne, CHU Grenoble, La Tronche, France
| | - Azeddine Dellal
- Service de rhumatologie, Hôpital Montfermeil, Montfermeil, France
| | - Nicolas Belhomme
- Service de médecine interne et immunologie clinique, CHU Rennes, Rennes, France
| | - Nathalie Saidenberg Kermanac'H
- Service de rhumatologie, Groupe hospitalier Avicenne-Jean Verdier-René Muret, APHP, Bobigny, France.,Sorbonne Paris Cité, Université Paris 13, INSERM U1125, Bobigny, France
| | | | - Martin Michaud
- Service de médecine interne, Hôpital Joseph Ducuing, Toulouse, France
| | - Sylvain Lanot
- Service de rhumatologie, C.H intercommunal Alençon-Mamers, Alençon, France
| | - Fabrice Carrat
- Sorbonne Université, Service de santé publique, Hôpital Saint-Antoine, APHP, Paris, France.,Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Paris, France
| | - Olivier Fain
- Sorbonne Université, Service de médecine interne, Hôpital Saint-Antoine, DHU I2B: Inflammation, Immunopathologie, Biothérapie, APHP, Paris, France
| | - Arsène Mékinian
- Sorbonne Université, Service de médecine interne, Hôpital Saint-Antoine, DHU I2B: Inflammation, Immunopathologie, Biothérapie, APHP, Paris, France
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Ogbue OD, Malhotra P, Akku R, Jayaprakash T, Khan S. Biologic Therapies in Sarcoidosis and Uveitis: A Review. Cureus 2020; 12:e9057. [PMID: 32782876 PMCID: PMC7413313 DOI: 10.7759/cureus.9057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Sarcoidosis and uveitis are chronic inflammatory conditions with potentially debilitating effects on quality of life. Steroids form the mainstay standard therapy in both conditions. Biologic agents are considered to be appropriate alternatives for treatment in steroid-refractory sarcoidosis and uveitis due to the role of tumor necrosis factor (TNF) in mediating the inflammatory cascade seen in both conditions. We performed a thorough literature search using PubMed to compare the extent of use, efficacy, and safety profile of individual anti-TNF agents in the management of these conditions. Our review consists of two systematic reviews with meta-analysis, thirteen observational studies, and fifteen case series/reports. Infliximab had the widest range of organ-system usage in extra-pulmonary sarcoidosis but is equivalent to adalimumab in terms of efficacy. In uveitis, adalimumab was found to be the most efficacious agent for maintaining disease remission in adults and children with chronic non-infectious uveitis. Etanercept was neither used widely, nor was it efficacious in the management of either condition. In terms of safety profile, biologic agents were found to be well tolerated and have a similar safety profile. More randomized clinical trials are needed to inform evidence-based use of biologic agents in these conditions.
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Adler BL, Wang CJ, Bui TL, Schilperoort HM, Armstrong AW. Anti-tumor necrosis factor agents in sarcoidosis: A systematic review of efficacy and safety. Semin Arthritis Rheum 2019; 48:1093-1104. [DOI: 10.1016/j.semarthrit.2018.10.005] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Revised: 08/13/2018] [Accepted: 10/08/2018] [Indexed: 12/12/2022]
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Abstract
A letter in response to: Crommelin HA, Vorselaars AD, van Moorsel CH, Korenromp IH, Deneer VH, Grutters JC. Anti-TNF therapeutics for the treatment of sarcoidosis. Immunotherapy 6(10), 1127–1143 (2014).
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Affiliation(s)
| | - Vincent Goëb
- Rheumatology Department, Research Unit EA 4666, Amiens University Hospital, University of Picardie Jules-Verne, Amiens, France
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Osseous sarcoidosis: a case series. Rheumatol Int 2014; 35:925-33. [DOI: 10.1007/s00296-014-3170-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2014] [Accepted: 10/28/2014] [Indexed: 02/01/2023]
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10
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Des lésions des doigts. Rev Med Interne 2014; 35:769-71. [DOI: 10.1016/j.revmed.2013.12.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2013] [Accepted: 12/21/2013] [Indexed: 11/22/2022]
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