Introduction: Direct granulomatous inflammation of muscle is rare and likely underdiagnosed in patients with sarcoidosis. Therapeutic options for sarcoidosis myositis are not well described or standardized. Improved understanding of risk factors and clinical presentations of sarcoidosis associated myositis are needed to improve diagnosis and appropriate therapies.

Materials and Methods: We performed a retrospective analysis of patients at a single center FSR sarcoidosis clinic of excellence focused on the population with biopsy-proven sarcoidosis and muscle-biopsy-proven granulomatous inflammation. Prevalence, demographics, and therapeutic regimens were recorded.

Results: Four subjects out of 6600 patients met criteria for sarcoidosis associated myositis with a prevalence rate of .06%. 50% of subjects were male and 75% of subjects were African American. All four subjects were managed on long term infliximab infusions. 50% remained on long term prednisone in combination with other immunosuppression and 50% remained on chronic methotrexate. No opportunistic infections were seen in this cohort long term.

Conclusions: Sarcoidosis associated myositis with direct granulomatous inflammation of muscle groups is a rare and debilitating condition that often requires long term biologic therapies to preserve patient function. Registry data and improved screening are important for detection and referral for muscle biopsy where appropriate. Long term anti-tumor necrosis factor antibody therapy has shown benefit preserving functionality in this small cohort of patients.