Osseous sarcoidosis treated with tumor necrosis factor-inhibitors: case report and review of the literature

Spine (Phila Pa 1976). 2010 Aug 15;35(18):E904-7. doi: 10.1097/brs.0b013e3181dc9a54.

Abstract

Study design: Report of 2 cases of sarcoidosis involving vertebrae successfully treated with tumor necrosis factor-α inhibitor (TNF-α antagonist).

Objective: To disseminate knowledge concerning successful treatment of sarcoidosis involving the axial skeleton with the use of TNF-α blockers.

Summary of background data: Osseous sarcoidosis most commonly involves small bones of hands and feet; vertebral involvement is rare, and currently there is no consensus on optimal treatment.

Methods: Two cases are described detailing patients with extrapulmonary sarcoidosis involving vertebral bodies, retractable to conventional treatment, who were treated with TNF-α antagonists.

Results: We observed a remarkable response following the administration of TNF-α blockers in vertebral sarcoidosis with marked resolution of lytic lesions. The patients remained asymptomatic with no recurrence of their disease.

Conclusion: Vertebral sarcoidosis is a rare manifestation of osseous sarcoidosis. Symptomatic patients are treated with various immunosuppressive therapies. We propose utilizing TNF-α blocking agents in patients who fail to respond to first-line therapy.

Publication types

  • Case Reports
  • Review

MeSH terms

  • Adalimumab
  • Anti-Inflammatory Agents, Non-Steroidal / administration & dosage*
  • Antibodies, Monoclonal / administration & dosage
  • Antibodies, Monoclonal, Humanized / administration & dosage
  • Female
  • Humans
  • Infliximab
  • Middle Aged
  • Radiography
  • Sarcoidosis / diagnostic imaging
  • Sarcoidosis / drug therapy*
  • Sarcoidosis / pathology
  • Spinal Diseases / diagnostic imaging
  • Spinal Diseases / drug therapy*
  • Spinal Diseases / pathology
  • Spine / diagnostic imaging
  • Spine / drug effects*
  • Spine / pathology
  • Tumor Necrosis Factor-alpha / antagonists & inhibitors*
  • Tumor Necrosis Factor-alpha / immunology*

Substances

  • Anti-Inflammatory Agents, Non-Steroidal
  • Antibodies, Monoclonal
  • Antibodies, Monoclonal, Humanized
  • Tumor Necrosis Factor-alpha
  • Infliximab
  • Adalimumab