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Radiographs obtained of both hands showed similar changes in multiple phalanges. In particular, the lesions had a lacy, punched-out appearance that suggested osseous sarcoidosis, said Dr. Sterling G. West, a professor of medicine in the division of rheumatology at the University of Colorado at Denver.

The lesions reflect granulomatous involvement of the phalangeal shafts.

Notably, the lesions are not associated with periostitis or sequestra helping to separate sarcoid bone involvement from chronic osteomyelitis.

Sarcoidosis can have a number of manifestations, though pulmonary involvement is present in more than 90% of patients with the disease. Symptoms of pulmonary involvement include dyspnea and dry cough, as in this patient.

Patients tend to have well-established sarcoidosis by the time that bone involvement is present, said Dr. West. Bone involvement tends to occur more frequently in African Americans.

Cystic lesions have a predilection for the phalanges of the hands and feet. Soft tissue swelling can occur over the lesions. Sarcoidosis is the major cause of unidigital clubbing. When sarcoid bone involvement is associated with lupus pernio, the prognosis is generally poor.

Uveitis is another common manifestation of sarcoidosis and is usually bilateral. Dr. West recommends that all sarcoid patients get an eye screening.

Many patients with sarcoidosis undergo spontaneous remission, while some remit with steroids. Others may have a chronic course. Signs of poor prognosis include the involvement of three or more organs, disease onset after age 40, African American race, and symptoms lasting more than 6 months.

Osseous sarcoid typically indicates advanced sarcoidosis, which requires treatment with high-dose prednisone and additional agents such as azathioprine, methotrexate, or biologic agents—particularly infliximab to control all the sarcoidosis manifestations and prevent progression. This patient was initially treated with prednisone and azathioprine. Later, infliximab was added helping to stabilize his disease.

Osseous sarcoid lesions affected multiple phalanges (hand, above left). These bony changes typically have a lacy, punched-out appearance (detail, above right). Photos courtesy Dr. Sterling G. West

Radiographs obtained of both hands showed similar changes in multiple phalanges. In particular, the lesions had a lacy, punched-out appearance that suggested osseous sarcoidosis, said Dr. Sterling G. West, a professor of medicine in the division of rheumatology at the University of Colorado at Denver.

The lesions reflect granulomatous involvement of the phalangeal shafts.

Notably, the lesions are not associated with periostitis or sequestra helping to separate sarcoid bone involvement from chronic osteomyelitis.

Sarcoidosis can have a number of manifestations, though pulmonary involvement is present in more than 90% of patients with the disease. Symptoms of pulmonary involvement include dyspnea and dry cough, as in this patient.

Patients tend to have well-established sarcoidosis by the time that bone involvement is present, said Dr. West. Bone involvement tends to occur more frequently in African Americans.

Cystic lesions have a predilection for the phalanges of the hands and feet. Soft tissue swelling can occur over the lesions. Sarcoidosis is the major cause of unidigital clubbing. When sarcoid bone involvement is associated with lupus pernio, the prognosis is generally poor.

Uveitis is another common manifestation of sarcoidosis and is usually bilateral. Dr. West recommends that all sarcoid patients get an eye screening.

Many patients with sarcoidosis undergo spontaneous remission, while some remit with steroids. Others may have a chronic course. Signs of poor prognosis include the involvement of three or more organs, disease onset after age 40, African American race, and symptoms lasting more than 6 months.

Osseous sarcoid typically indicates advanced sarcoidosis, which requires treatment with high-dose prednisone and additional agents such as azathioprine, methotrexate, or biologic agents—particularly infliximab to control all the sarcoidosis manifestations and prevent progression. This patient was initially treated with prednisone and azathioprine. Later, infliximab was added helping to stabilize his disease.

Osseous sarcoid lesions affected multiple phalanges (hand, above left). These bony changes typically have a lacy, punched-out appearance (detail, above right). Photos courtesy Dr. Sterling G. West

Radiographs obtained of both hands showed similar changes in multiple phalanges. In particular, the lesions had a lacy, punched-out appearance that suggested osseous sarcoidosis, said Dr. Sterling G. West, a professor of medicine in the division of rheumatology at the University of Colorado at Denver.

The lesions reflect granulomatous involvement of the phalangeal shafts.

Notably, the lesions are not associated with periostitis or sequestra helping to separate sarcoid bone involvement from chronic osteomyelitis.

Sarcoidosis can have a number of manifestations, though pulmonary involvement is present in more than 90% of patients with the disease. Symptoms of pulmonary involvement include dyspnea and dry cough, as in this patient.

Patients tend to have well-established sarcoidosis by the time that bone involvement is present, said Dr. West. Bone involvement tends to occur more frequently in African Americans.

Cystic lesions have a predilection for the phalanges of the hands and feet. Soft tissue swelling can occur over the lesions. Sarcoidosis is the major cause of unidigital clubbing. When sarcoid bone involvement is associated with lupus pernio, the prognosis is generally poor.

Uveitis is another common manifestation of sarcoidosis and is usually bilateral. Dr. West recommends that all sarcoid patients get an eye screening.

Many patients with sarcoidosis undergo spontaneous remission, while some remit with steroids. Others may have a chronic course. Signs of poor prognosis include the involvement of three or more organs, disease onset after age 40, African American race, and symptoms lasting more than 6 months.

Osseous sarcoid typically indicates advanced sarcoidosis, which requires treatment with high-dose prednisone and additional agents such as azathioprine, methotrexate, or biologic agents—particularly infliximab to control all the sarcoidosis manifestations and prevent progression. This patient was initially treated with prednisone and azathioprine. Later, infliximab was added helping to stabilize his disease.

Osseous sarcoid lesions affected multiple phalanges (hand, above left). These bony changes typically have a lacy, punched-out appearance (detail, above right). Photos courtesy Dr. Sterling G. West