Clinical Experience with TNF Inhibition and Longitudinal Image Monitoring in Osseous Sarcoidosis

Area of Science:

• Rheumatology
• Immunology
• Radiology

Background:

• Osseous sarcoidosis is a rare manifestation of sarcoidosis affecting the bones.
• Tumor necrosis factor (TNF) inhibitors have emerged as a potential treatment for refractory sarcoidosis.
• This case series investigates the efficacy of TNF inhibition in osseous sarcoidosis.

Purpose of the Study:

• To present longitudinal imaging surveillance of osseous sarcoidosis cases treated with TNF inhibition.
• To evaluate the effectiveness of TNF inhibition in achieving clinical remission and imaging response.
• To identify imaging predictors of disease progression and treatment outcomes.

Main Methods:

• Retrospective review of 6 patients with pathologically confirmed osseous sarcoidosis treated with TNF inhibitors.
• Longitudinal imaging studies including PET/CT, MRI, and bone scintigraphy were utilized for surveillance.
• Clinical data were extracted from electronic medical records.

Main Results:

• All 6 patients achieved clinical remission with TNF inhibition (adalimumab or infliximab).
• Complete imaging response was observed in 5 out of 6 patients within 3 to 8 months.
• Progression of asymptomatic lesions on imaging preceded bone pain development in some cases.

Conclusions:

• Longitudinal imaging is valuable for assessing disease activity, surveillance, and treatment response in osseous sarcoidosis.
• TNF inhibition is a successful therapeutic strategy for osseous sarcoidosis, leading to remission in all cases.
• Discontinuation of TNF inhibition may result in disease recurrence, necessitating long-term immunosuppressive therapy.