Central skeletal sarcoidosis: a case report with sustained remission only on methotrexate, and a literature review on the imaging approach, treatment, and assessment of disease activity

Abstract

We report a case of multifocal involvement of the central skeleton in a patient with long-term stage I pulmonary sarcoidosis who experienced sustained clinical remission of musculoskeletal symptoms while on methotrexate (MTX) alone. Concomitant normalization of laboratory tests [inflammatory markers and angiotensin-converting enzyme (ACE) levels] was observed, and improvements were seen in follow-up magnetic resonance imaging (MRI) of the lumbar spine and bone scintigraphy. To date, there are no specific tools for the assessment of skeletal disease activity in sarcoidosis. Our case suggests that inflammatory markers and ACE levels, when initially elevated, bone scintigraphy, and-in the case of vertebral involvement-MRI could serve as such tools. A literature review on the imaging approach, treatment, and disease activity monitoring of skeletal sarcoidosis is also provided.

A Japanese Case of Vertebral Sarcoidosis

“…The prednisolone dose is usually 15-40 mg/day, which is tapered according to the clinical response. In patients who are refractory to corticosteroids, treatment with MTX, infliximab and adalimumab has been reported to be potent (10,12,21,27). In our case, MTX was found to be effective.…”

“…The thoracic spine is the most frequently affected site in patients with vertebral sarcoidosis, although any area of the spine can be involved (7). Patients with vertebral sarcoidosis nearly always present with radicular back pain both during activity and at rest (8)(9)(10). Our patient also experienced lumbar pain with immediate pain relief after treatment.…”

“…Corticosteroids, such as prednisolone, are often used as first-line treatment for skeletal sarcoidosis and can achieve a good response (10,13,17,26). The prednisolone dose is usually 15-40 mg/day, which is tapered according to the clinical response.…”

Health status of sarcoidosis patients in baseline and in 10 years under different treatment strategies (multicenter analysis)

“…Продолжаются исследования препа ратов, влияющих на фактор некроза опухоли альфа (TNF α). Метотрексат особенно успешно применя ется при внелегочных формах саркоидоза [3], пен токсифиллин позволяет снижать дозы сГКС при сохранении клинической динамики [4]. Мы ранее также с успехом применяли при саркоидозе пенто ксифиллин в сочетании с токоферола ацетатом [5].…”

Efficiency and Safety of Leflunomide Treatment in Patients With Pulmonary Sarcoidosis

“…The work on the study of immunosuppressants in the treatment of patients with respiratory sarcoidosis is few, only one randomized study of the effectiveness of methotrexate in a small group of patients (24 patients) was conducted [9,10]. Experts of the World Association of Sarcoidosis and other Granulomatous Lesions (WASOG) analyzed literature data on the effectiveness of methotrexate in limited series of observations and developed general recommendations for its use [11,12].…”