Vertebral sarcoidosis: diagnosis to management


Sarcoidosis; spine; diagnosis; imaging; treatment

Published online: Feb 17 2023

Hanene Lassoued Ferjani, Safa Rahmouni, Dorra Ben Nessib, Wafa Triki, Kaouther Maatallah, Dhia Kaffel, Wafa Hamdi

From the Rheumatology department, Kassab orthopedics institute, Ksar Saïd, Tunisia


Sarcoidosis is a systemic inflammatory granulomatous disease that can develop in almost any organ system. Rheumatologists may encounter sarcoidosis in different situations varying from arthralgia to bone involvement. While the peripheral skeleton was a frequent location, data regarding axial involvement is scarce.

Most patients with vertebral involvement have a known diagnosis of intrathoracic sarcoidosis. They tend to report mechanical pain or tenderness over the involved area.

Imaging modalities, particularly Magnetic Resonance Imaging (MRI), are a mainstay of axial screening. It helps exclude differential diagnoses and delineate the extent of bone involvement. Histological confirmation combined with the ap- propriate clinical and radiological presentation is the key of diagnosis.

Corticosteroids remain the cornerstone of treatment. In refractory cases, methotrexate is the steroid- sparing agent of choice. Biologic therapies may be used, although the evidence base for their efficacy is bone sarcoidosis controversial.