Resolution of Osseous Sarcoidosis with Methotrexate

Kanner, Christopher D.; Libman, Bonita; Merchand, Morgan; Lemos, Diego F.

doi:10.1155/2019/4156313

Cited by 5 publications

(6 citation statements)

References 14 publications

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“…Quoique la corticothérapie à faible ou moyenne dose est utilisée en première intention mais son efficacité sur le plan structural n'est pas démontrée [8]. En absence de réponse ou en cas d'aggravation le méthotrexate ou l'hydroxychloroquine peuvent être prescrits, leurs efficacités ne reposent que sur des courtes séries ouvertes et quelques observations de cas [2][3][4]. L'évolution structurale reste souvent lente sur plusieurs années comme dans notre observation.…”

Section: Discussionunclassified

“…L'évolution structurale reste souvent lente sur plusieurs années comme dans notre observation. Finalement, les anti TNF alpha peuvent être utilisés en cas d'échec des traitements classiques [2][3][4]. Notre cas est instructif pour deux raisons.…”

Section: Discussionunclassified

“…Elles apparaissent souvent au cours de l'évolution de la maladie [2]. Le diagnostic est peut-être évident devant un contexte clinique évocateur et une présentation radiologique typique mais le traitement est le plus souvent délicat [3,4]. L'emploi et l'efficacité du méthotrexate en association avec l'hydroxychloroquine dans le traitement de l'atteinte osseuse sarcoïdosique est peu décrit [4].…”

Section: Introductionunclassified

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La sarcoïdose osseuse : Quand les controverses sur le traitement s’opposent à l’évidence du diagnostic

Tahir,

Akasbi,

El Mezouar

et al. 2024

Rhum Afr Franc

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La sarcoïdose est une granulomatose systémique à tropisme pulmonaire. La localisation osseuse est beaucoup plus rare et souvent la résultante d’une maladie évolutive, chronique et multiviscérale, elle touche préférentiellement les petits os des mains et des pieds. Le diagnostic d’une sarcoïdose osseuse peut être évident devant un contexte clinique et une présentation radiologique évocateurs mais devant l’absence de lignes directrices thérapeutiques, la prise en charge de cette maladie reste compliquée. Cet article va vous exposer le cas d’une patiente qui présente une sarcoïdose osseuse avec un diagnostic évident devant son antécédent de sarcoïdose pulmonaire et cutanéo-muqueuse ainsi que ses images radiographiques typiques. Dans notre observation, le méthotrexate en association à l’hydroxychloroquine a permis un contrôle satisfaisant de la maladie

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Section: Discussionunclassified

Section: Introductionunclassified

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La sarcoïdose osseuse : Quand les controverses sur le traitement s’opposent à l’évidence du diagnostic

Tahir,

Akasbi,

El Mezouar

et al. 2024

Rhum Afr Franc

View full text Add to dashboard Cite

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“…Treatment of osseous sarcoidosis is lacking guidelines. 16 There are reported cases of improvement and complete healing without any treatment, 17 the use of nonsteroidal anti-inflammatory drugs, corticosteroids, methotrexate, hydroxychloroquine, azathioprine, leflunomide and tumor necrosis factor-alpha inhibitors, or their combination. 7,14,18 Treatment experience is based mainly on case reports and single-center studies with low patient numbers.…”

Section: Discussionmentioning

confidence: 99%

Fracture of the Dens Axis Due to Spinal Manifestation of Sarcoidosis

Eid

Friedrich

Kudlek

et al. 2021

Spine

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Study Design. Case report and literature review. Objective. We present a case of a pathologic unstable fracture of the odontoid process due to vertebral osseous sarcoidosis. The surgical management of this unreported pathology is described and a review of the literature is given. Summary of Background Data. Sarcoidosis is a chronic inflammatory systemic disease of unknown etiology, characterized by multiorgan noncaseating granulomatous infiltrations. It affects primarily the lungs, lymphatic system, eyes, skin, heart, and nervous system. Osseous sarcoidosis is usually clinically asymptomatic and therefore frequently under-diagnosed. When it does affect the skull or vertebral column, specific surgical therapy is only necessary in cases with nonmanageable pain or where structural integrity is threatened. Methods. Our patient underwent a so-called semiconservative approach, consisting of a minimally invasive transoral-transpharyngeal approach, surgical debridement of the lytic bony lesion, transplantation of cancellous homologous bone, and carbon chest halo-immobilization. Halo-immobilization was left for 8 weeks, followed by a further 6 weeks with a hard cervical collar. Results. Routine computed tomography scans 3 days, 6, 12, 18 weeks, and 1 year after surgery showed good filling of the original defect with cancellous bone, correct alignment of the upper cervical spine, and progressive fracture consolidation and stability. Surgical site infection (SSI) was not observed. The patient had no neurological postoperative deficits. After initial dysphagia, swallowing was not permanently impaired. Conclusion. Sarcoidosis-induced odontoid fractures can be managed successfully using a semiconservative approach, consisting of transoral-transmucosal, minimally invasive surgical procedure for debridement of the lesion and transplantation of cancellous bone with additional halo-immobilization. Permanent fusion of C1-2 with loss of the cervical range of motion is avoided. Despite performing bone surgery in a potentially markedly contaminated site, bacterial infection was not an issue, possibly supported by the temporary discontinuation of immunosuppressive agents and the prudent use of antibiotics.

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“…Conventional synthetic diseasemodifying antirheumatic drugs (csDMARDs) are used as the third line of therapy [29]. MTX used alone has been reported to be useful for the treatment of osseous sarcoidosis [12,30]. The addition of MTX to GCS in first line therapy could act as a steroid-sparing agent to reduce toxicity in bone sarcoidosis and in treatment of variety of organ symptoms [31,32].…”

Section: Treatment Of Bone Sarcoidosismentioning

confidence: 99%

Imaging Plays a Key Role in the Diagnosis and Control of the Treatment of Bone Sarcoidosis

Błasińska¹,

Jędrych²,

Opoka³

et al. 2023

Biomedicines

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Sarcoidosis is a multisystem granulomatous disease of unknown origin. The most frequent localizations are thoracic lymph nodes and/or parenchymal lung disease, nevertheless any other organ may be involved. Musculoskeletal sarcoidosis, previously considered a rare manifestation of the disease, is presently recognized with increasing frequency, due to the development of modern imaging modalities. The classical X-ray sign of bone sarcoidosis is the image of lace in the phalanges of the hands. Most other locations present with atypical radiological images. Therefore, they may mimic metastatic neoplastic disease, especially when they are the first sign of sarcoidosis not previously recognized. On such occasions, none of the imaging methods will give the correct diagnosis, histopathological verification, monitoring of lesions or clinical data in a patient with confirmed sarcoidosis are indicated. The article summarizes the current status of knowledge concerning the recognition and therapy of bone sarcoidosis. In addition, an illustrative case of patient with bone and bone marrow sarcoidosis is presented.

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Resolution of Osseous Sarcoidosis with Methotrexate

Cited by 5 publications

References 14 publications

La sarcoïdose osseuse : Quand les controverses sur le traitement s’opposent à l’évidence du diagnostic

La sarcoïdose osseuse : Quand les controverses sur le traitement s’opposent à l’évidence du diagnostic

Fracture of the Dens Axis Due to Spinal Manifestation of Sarcoidosis

Imaging Plays a Key Role in the Diagnosis and Control of the Treatment of Bone Sarcoidosis

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