Allanore Y, Perrot S, Menkès C J, Kahan A
Université Paris 5, Service de rhumatologie A, h pital Cochin, France.
Joint Bone Spine. 2001 Mar;68(2):175-7. doi: 10.1016/s1297-319x(01)00251-2.
Dactylitis and calcaneitis developed in a patient with untreated sarcoidosis of the skin and lungs. Radiographs showed a defect in the second phalanx of the left middle finger. Radiographs of the feet were normal, but magnetic resonance imaging demonstrated a defect in the left calcaneus. Methylprednisolone therapy (1 g per day for 3 consecutive days) induced a dramatic improvement within 48 hours. Low-dose oral glucocorticoid therapy was given subsequently. One year later, a recurrent episode of dactylitis responded promptly to the same regimen. Maintenance therapy was given, and no further recurrences were noted during the four-year follow-up. Sarcoid bone lesions are uncommon and arise selectively in the small bones of the hands and feet. Involvement of the calcaneus is exceedingly rare, and its treatment is not standardized. In our patient, glucocorticoid therapy combined with methotrexate and hydroxychloroquine were effective in controlling the disease.
一名皮肤和肺部结节病未经治疗的患者出现了指（趾）炎和跟骨炎。X线片显示左手中指第二指骨有缺损。足部X线片正常，但磁共振成像显示左跟骨有缺损。甲泼尼龙治疗（连续3天每天1g）在48小时内带来显著改善。随后给予低剂量口服糖皮质激素治疗。1年后，指（趾）炎复发，采用相同方案治疗后迅速缓解。给予维持治疗，在4年随访期间未再出现复发。结节病骨病变并不常见，且选择性地出现在手足小骨中。跟骨受累极为罕见，其治疗尚无标准化方案。在我们的患者中，糖皮质激素治疗联合甲氨蝶呤和羟氯喹在控制病情方面有效。
