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2015 ; 7
(5
): 196-205
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Sarcoidosis: a rheumatologist s perspective
#MMPMID26425148
Kobak S
Ther Adv Musculoskelet Dis
2015[Oct]; 7
(5
): 196-205
PMID26425148
show ga
Sarcoidosis is a systemic disorder of unknown etiology, which may involve various
tissues and organs and is characterized by a noncaseating granuloma reaction.
While pathogenesis is not yet clear, cellular immune system activation and
nonspecific inflammatory response occur secondarily to several genetic and
environmental factors. T helper 1-cells and macrophage-derived pro-inflammatory
cytokines stimulate the inflammatory cascade and formation of granuloma occurs as
a result of tissue permeability, cell influx, and local cell proliferation. The
different prevalence, clinical results, and disease course observed in different
races and ethnic groups, is an indicator of the heterogeneous nature of the
disease. Sarcoidosis may mimic and/or may occur concomitantly with numerous
primary rheumatic diseases. This disease most commonly presents with bilateral
hilar lymphadenopathy, pulmonary infiltrations, and skin and eye lesions.
Locomotor system involvement is observed at a range of 15% and 25%. Two major
joint involvements have been described: acute and chronic form. The most common
form, the acute form, may be the first sign of sarcoidosis and present with
arthralgia, arthritis, or periarthritis. Chronic sarcoid arthritis is usually
associated with pulmonary parenchymal disease or other organ involvement and
occurs rarely. While asymptomatic muscular involvement is reported between 25%
and 75%, symptomatic muscular involvement is very rare. Symptomatic myopathy may
present as three different types: chronic myopathy, palpable nodular myositis, or
acute myositis. Even if rare, 2-5% of cases may exhibit osseous involvement and
it is frequently associated with lupus pernio, chronic uveitis, and multisystemic
disease. Sarcoidosis was reported together with different rheumatologic diseases.
There are studies showing that sarcoidosis may mimic the clinical and laboratory
findings of these disorders. Nonsteroidal anti-inflammatory drugs and
corticosteroids are used for treating the symptoms of rheumatologic findings. In
patients who are unresponsive to corticosteroids, immunosuppressive and
anti-tumor necrosis factor alpha drugs may be used. In this review, the incidence
of rheumatologic symptoms, the clinical findings, and the treatment of
rheumatologic manifestations of sarcoidosis are discussed.
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