Sarcoidosis and the rheumatologist

Abstract

The purpose of this review is to discuss challenges in the diagnosis and treatment of sarcoidosis by rheumatologists. Sarcoidosis is a heterogeneous multisystem granulomatous disease. Rheumatologists are faced with multiple challenges in the management of this disease. Features that can have similarities to many rheumatic diseases are being increasingly reported. There are many reports of sarcoidosis coexisting with or mimicking rheumatic diseases such as systemic lupus erythematosus, rheumatoid arthritis, and ankylosing spondylitis. Musculoskeletal features of sarcoidosis can also mimic infection and malignancy. Biomarkers for the diagnosis and monitoring of treatment of response are lacking. Tumor necrosis factor (TNF) inhibition therapy is a viable alternative for immunodulation for various manifestations. However, increased vigilance is needed, as there are also emerging reports of drug-induced sarcoidosis in association with the use of anti-TNFalpha agents and other medications. This article reviews these diagnostic and treatment challenges that rheumatologists face. Many questions remain to be answered. More studies looking at the reliability of certain serological and radiological biomarkers are needed. Issues concerning the safety of the use of biological response modifiers in inducing sarcoidosis need further study.