title: 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.
authors.affiliation: Department of Rheumatology, 424 General Military Hospital, Ring Road N.Efkarpias, 564 03, Thessaloniki, Greece. sakelgr@gmail.com
authors.forename: Grigorios T
authors.initials: GT
authors.lastname: Sakellariou
authors.forename: Athanasios D
authors.initials: AD
authors.lastname: Anastasilakis
authors.forename: Dimitrios
authors.initials: D
authors.lastname: Karanikolas
authors.forename: Periklis
authors.initials: P
authors.lastname: Vounotrypidis
authors.forename: Charalampos
authors.initials: C
authors.lastname: Berberidis
mesh_terms: D001847:Bone Diseases / Q000175:diagnosis* / Q000188:drug therapy* / Q000503:physiopathology; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging / Q000473:pathology; D008279:Magnetic Resonance Imaging; D008297:Male; D008727:Methotrexate / Q000627:therapeutic use*; D008875:Middle Aged; D007703:Peptidyl-Dipeptidase A / Q000097:blood; D011877:Radionuclide Imaging / Q000379:methods; D012074:Remission Induction; D012507:Sarcoidosis / Q000175:diagnosis* / Q000188:drug therapy* / Q000503:physiopathology; D016896:Treatment Outcome
chemical_list: D007166:Immunosuppressive Agents; C488034:ACE protein, human; D007703:Peptidyl-Dipeptidase A; D008727:Methotrexate