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Background: Sarcoidosis, a systemic disease characterized by non-caseating granulomas within affected organs, typically targets the lungs. However, approximately 10–25% of cases manifest musculoskeletal (MSK) involvement of joints, muscles and bone tissue. Literature on the efficacy and safety of TNF-alpha inhibitors (TNFi) for treatment of MSK sarcoidosis is limited.
Objectives: Thus, we examined our experience with treatment of MSK sarcoidosis with TNFi.
Methods: We conducted an IRB-approved, retrospective EMR search using ICD-9 codes followed by EMR review of individual records to identify patients with MSK sarcoid seen in the Rheumatology clinic at the University of Iowa Hospitals and Clinics and the Iowa City Veterans Affairs Medical Center between January 1, 2000 and December 31, 2014. The diagnosis of MSK sarcoidosis was confirmed based on the presence of Löfgren's syndrome triad or positive pathology on biopsy of MSK tissue. We extracted from cases of MSK sarcoidosis variables on demographics, clinical manifestations, type and length of treatment, treatment response, relapse and adverse events.
Results: Retrospective chart review of 340 patients with sarcoidosis yielded 26 cases with MSK involvement, 7 fulfilling Löfgren's syndrome triad (27%) and 19 with biopsy-proven MSK sarcoid (73%). The mean age was 50 yrs and majority were females. 19 patients presented with arthritis (7 Lofgren's and 13 chronic, oligoarticular), 2 with sarcoid myopathy, and 4 with osseous sarcoid. MSK sarcoid symptoms were controlled in 69% of patients with maintenance methotrexate and/or hydroxychloroquine. 8 patients received TNFi due to failure of DMARDs. Long-term efficacy of TNFi was low (Table 1).
Table 1. Clinical outcomes of TNFi treatment of MSK sarcoidosis
Age/Sex Condition Drug Total therapy Outcome Side effect 54/M Osseous sarcoidosis Infliximab 8 yrs Intolerance Serum sickness 65/F Osseous sarcoidosis Infliximab 6 mo Ineffective None 69/M Myopathy Infliximab 8 yrs Ineffective None 54/F Chronic arthritis Infliximab 9 yrs Relapsed None 57/F Chronic arthritis Adalimumab 7 yrs Ineffective None 50/F Chronic arthritis Adalimumab 10 yrs Effective None 54/M Osseous sarcoidosis Adalimumab 2 yrs Relapse None 54/M Osseous sarcoidosis Etanercept 1 yr Effective Oral ulcers
Conclusions: To our best knowledge, this study represents the largest case series of MSK sarcoidosis in North America since 1985. We also present data on outcomes of TNFi use in different forms of MSK sarcoid. In most patients standard DMARD therapy controlled symptoms of MSK sarcoid. TNFi benefited a few patients long term who failed oral DMARDs. Our case series underscores the need for identifying novel targets of treatment for the nearly one-third of patients with MSK sarcoid who fail standard DMARD treatment.
References:
1. Banse C, Bisson-Vaivre A, Kozyreff-Meurice M, Vittecoq O, Goeb V. No impact of tumor necrosis-factor antagonists on the joint manifestations of sarcoidosis. Int J Gen Med. 2013;6:605–11.
2. Visser H, Vos K, Zanelli E, Verduyn W, Schreuder GM, Speyer I, et al. Sarcoid arthritis: clinical characteristics, diagnostic aspects, and risk factors. Ann Rheum Dis. 2002;61(6):499–504.
3. Perruquet JL, Harrington TM, Davis DE, Viozzi FJ. Sarcoid arthritis in a North American Caucasian population. J Rheumatol. 1984;11(4):521–5.
Disclosure of Interest: M. Arakane Shareholder of: none, Grant/research support from: none, Consultant for: none, Employee of: none, Paid instructor for: none, Speakers bureau: none, S. Vogelgesang Shareholder of: none, Grant/research support from: none, Consultant for: none, Employee of: none, Paid instructor for: none, Speakers bureau: none, Z. ballas: None declared, N. Singh Shareholder of: none, Grant/research support from: none, Consultant for: none, Employee of: none, Paid instructor for: none, Speakers bureau: none
DOI: 10.1136/annrheumdis-2016-eular.1459