Sarcoidosis is a disease that exhibits extremely heterogeneous clinical manifestations. Although the lungs are the most commonly involved organs, the extension of the granulomatous process may also affect the bones. Almost any bone can be involved; curiously, the small bones of the hands and feet are most frequently affected. Diagnosis and recognition of osseous sarcoidosis is easy, but the therapy is disappointing. Corticosteroids and antimalarials may control pain and swelling, but usually do not influence the course of osseous sarcoidosis.
More than a century ago, Jonathan Hutchinson, a surgeon-dermatologist, described the first case of sarcoidosis at King’s College Hospital in London. Although for the better part of the twentieth century the disease has remained confined to the domain of the chest physician, its multisystem nature has been widely recognized [1•,2,3]. Now, in the twenty-first century, clinicians of different disciplines, radiologists, pathologists, immunologists, biochemists, rheumatologists, and geneticists face the problem of finding the cause of sarcoidosis. The clinical and radiologic features of pulmonary sarcoidosis are relatively easy to recognize, but the diagnosis is often delayed or even completely missed because of its resemblance to tuberculosis, berylliosis, fungal infections, and collagen vascular disease, particularly in those patients who suffer from extrapulmonary involvement. The following description combines the pathogenesis, clinical features, biochemical changes, and immunologic features of pulmonary and osseous forms of sarcoidosis and provides an outline for the diagnosis and the management of bone sarcoidosis.