Sarcoidosis is a systemic multisystem inflammatory disease of unknown etiology. The disease is characterized by formation of non-caseating granulomas. The most common presentation is bilateral hilar lymphadenopathy and lung infiltration, but the disease is very heterogeneous, with an unpredictable clinical course. Musculoskeletal manifestations are common. Bone involvement is less frequent, and usually occurs in patients with chronic multisystem course of the disease. They are most commonly found in the phalanges of hands and feet, and are usually bilateral. The skull, long bones, ribs, pelvis, and axial skeleton may also be affected. Osseous involvement may be asymptomatic but in some cases can cause a severe disability. Imaging techniques are important for diagnosis. Radiological investigations revealed sclerotic or destructive lesions (involving also joints), cystic and punched out lesions and cortical abnormalities. Biopsy is required for differential diagnosis with respect to malignancy. Treatment is a part of systemic therapy and is not needed in all cases. Glucocorticoids and TNF-α antagonists are used for management.

Chronic leg ulceration is a frequent condition in elderly patients. Chronic wounds that are nonresponsive to 3-month therapy affect approximately 6.5 million people in the United States with a prevalence of 1% and costs estimated at 25 billion dollars per year. Although the main causes are venous insufficiency, lower extremity arterial disease and diabetes, in many cases the etiology is multi-factorial. Approximately 20–23% of non-healing wounds that are refractory to vascular intervention have other etiologies including vasculitis, rheumatoid arthritis and Sjögren syndrome. Adverse drug interactions are the least commonly considered, especially those which involve disease-modifying anti-rheumatic drugs. The authors present a report on a female patient with reported Sjögren syndrome, multiple morbidities and non-healing lower limb ulceration that developed during treatment with methotrexate, and no significant improvement after discontinuation of the drug and after vascular surgery. Microvascular deterioration caused by beta-blockers was considered decisive. Calcium-blocker replacement brought complete healing in the follow-up.

Rheumatoid arthritis (RA) is one of the most common rheumatic diseases, associated with cooccurrence of serious side effects. This study discusses the problems associated with chronic RA, well-known as osteoporosis, but also recently recognized as sarcopenia. Relationships between sarcopenia and rheumatic diseases are not yet fully understood. Co-occurrence of osteoporosis and sarcopenia, referred to as osteosarcopenia, is becoming increasingly important. The overlap of the effects of RA and osteosarcopenia and the adverse effects of glucocorticosteroids leads to progressive impairment of the musculoskeletal system, increasing the risk of falls, fractures, institutionalization and death, and it is a source of dramatic socioeconomic burden on society. Very limited options for effective treatment of developed osteosarcopenia, as well as the severity of complications caused by it, advocates for the need of broad education and raising public awareness, especially among health care workers, in order to implement the prevention of osteosarcopenia as early as possible.