Osseous Sarcoidosis Treated With Tumor Necrosis Factor-Inhibitors Case Report and Review of the Literature

Study Design. Report of 2 cases of sarcoidosis involving vertebrae successfully treated with tumor necrosis factor-alpha inhibitor (TNF-alpha antagonist). Objective. To disseminate knowledge concerning successful treatment of sarcoidosis involving the axial skeleton with the use of TNF-alpha 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-alpha antagonists. Results. We observed a remarkable response following the administration of TNF-alpha 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-alpha blocking agents in patients who fail to respond to first-line therapy.