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Obi ON. Anti-inflammatory Therapy for Sarcoidosis. Clin Chest Med 2024; 45:131-157. [PMID: 38245362 DOI: 10.1016/j.ccm.2023.08.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2024]
Abstract
Over 50% of patients with sarcoidosis will require anti-inflammatory therapy at some point in their disease course. Indications for therapy are to improve health-related quality of life, prevent or arrest organ dysfunction (or organ failure) or avoid death. Recently published treatment guidelines recommended a stepwise approach to therapy however there are some patients for whom up front combination or more intense therapy maybe reasonable. The last decade has seen an explosion of studies and trials evaluating novel therapeutic agents and treatment strategies. Currently available anti-inflammatory therapies and several novel therapies are discussed here.
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Affiliation(s)
- Ogugua Ndili Obi
- Department of Internal Medicine, Division of Pulmonary Critical Care and Sleep Medicine, Brody School of Medicine, East Carolina University, Greenville, NC, USA.
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2
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Trul-Kreuze IA, Akkerman M, Kieboom EAM, Nieuwenhuis MK, Houdijk H, Bongers BC. Clinimetric Properties of the Steep Ramp Test to Assess Cardiorespiratory Fitness, Its Underlying Physiological Responses, and Its Current Applications: A Scoping Review. Arch Phys Med Rehabil 2024:S0003-9993(24)00827-X. [PMID: 38412899 DOI: 10.1016/j.apmr.2024.02.717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Revised: 01/29/2024] [Accepted: 02/09/2024] [Indexed: 02/29/2024]
Abstract
OBJECTIVE Providing an overview of the clinimetric properties of the steep ramp test (SRT)-a short-term maximal exercise test-to assess cardiorespiratory fitness (CRF), describing its underlying physiological responses, and summarizing its applications in current clinical and research practice. DATA SOURCES MEDLINE (through PubMed), CINAHL Complete, Cochrane Library, EMBASE, and PsycINFO were searched for studies published up to July 2023, using keywords for SRT and CRF. STUDY SELECTION Eligible studies involved the SRT as research subject or measurement instrument and were available as full text articles in English or Dutch. DATA EXTRACTION Two independent assessors performed data extraction. Data addressing clinimetric properties, physiological responses, and applications of the SRT were tabulated. DATA SYNTHESIS In total, 370 studies were found, of which 39 were included in this study. In several healthy and patient populations, correlation coefficients between the work rate at peak exercise (WRpeak) attained at the SRT and oxygen uptake at peak exercise during cardiopulmonary exercise testing (CPET) ranged from .771-.958 (criterion validity). Repeated measurements showed intraclass correlation coefficients ranging from .908-.996 for WRpeak attained with the first and second SRT (test-retest reliability). Physiological parameters, like heart rate and minute ventilation at peak exercise, indicated that the SRT puts a lower burden on the cardiopulmonary system compared to CPET. The SRT is mostly used to assess CRF, among others as part of preoperative risk assessment, and to personalize interval training intensity. CONCLUSIONS The SRT is a practical short-term maximal exercise test that is valid for CRF assessment and to monitor changes in CRF over time in various healthy and patient populations. Its clinimetric properties and potential applications make the SRT of interest for a widespread implementation of CRF assessment in clinical and research practice and for personalizing training intensity and monitoring longitudinal changes in CRF.
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Affiliation(s)
- Ingeborg A Trul-Kreuze
- Association of Dutch Burn Centers, Burn Center Groningen, Martini Hospital, Groningen; Hanze University of Applied Sciences, Research Group Healthy Ageing, Allied Health Care and Nursing, Groningen; Center for Human Movement Sciences, University of Groningen, University Medical Center Groningen, Groningen
| | - Moniek Akkerman
- Association of Dutch Burn Centers, Burn Center Groningen, Martini Hospital, Groningen; Hanze University of Applied Sciences, Research Group Healthy Ageing, Allied Health Care and Nursing, Groningen
| | - Eleonora A M Kieboom
- Center for Human Movement Sciences, University of Groningen, University Medical Center Groningen, Groningen
| | - Marianne K Nieuwenhuis
- Association of Dutch Burn Centers, Burn Center Groningen, Martini Hospital, Groningen; Hanze University of Applied Sciences, Research Group Healthy Ageing, Allied Health Care and Nursing, Groningen; Center for Human Movement Sciences, University of Groningen, University Medical Center Groningen, Groningen
| | - Han Houdijk
- Center for Human Movement Sciences, University of Groningen, University Medical Center Groningen, Groningen
| | - Bart C Bongers
- Center for Human Movement Sciences, University of Groningen, University Medical Center Groningen, Groningen; Department of Nutrition and Movement Sciences, NUTRIM, Institute of Nutrition and Translational Research in Metabolism, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht; Department of Surgery, NUTRIM, Institute of Nutrition and Translational Research in Metabolism, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands.
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3
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Kim JS, Gupta R. Clinical Manifestations and Management of Fibrotic Pulmonary Sarcoidosis. J Clin Med 2023; 13:241. [PMID: 38202248 PMCID: PMC10780222 DOI: 10.3390/jcm13010241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Revised: 12/22/2023] [Accepted: 12/27/2023] [Indexed: 01/12/2024] Open
Abstract
Fibrotic pulmonary sarcoidosis represents a distinct and relatively uncommon manifestation within the spectrum of sarcoidosis and has substantial morbidity and mortality. Due to the scarcity of research focused on this specific disease subtype, our current understanding of pathogenesis and optimal management remains constrained. This knowledge gap underscores the need for further investigation into areas such as targeted therapies, lung transplantation, and quality of life of patients with fibrotic pulmonary sarcoidosis. The primary aim of this review is to discuss recent developments within the realm of fibrotic pulmonary sarcoidosis to foster a more comprehensive understanding of the underlying mechanisms, prognosis, and potential treatment modalities.
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Affiliation(s)
- Jin Sun Kim
- Department of Thoracic Medicine and Surgery, Temple University Hospital, Philadelphia, PA 19140, USA
| | - Rohit Gupta
- Department of Thoracic Medicine and Surgery, Lewis Katz School of Medicine, Temple University Hospital, Philadelphia, PA 19140, USA;
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Kim JS, Gupta R. Lung transplantation in pulmonary sarcoidosis. J Autoimmun 2023:103135. [PMID: 37923622 DOI: 10.1016/j.jaut.2023.103135] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Revised: 10/12/2023] [Accepted: 10/18/2023] [Indexed: 11/07/2023]
Abstract
Sarcoidosis is a systemic inflammatory disease of unknown etiology and variable clinical course. Pulmonary sarcoidosis is the most common presentation and accounts for most morbidity and mortality related to sarcoidosis. While sarcoidosis generally has good outcomes, few patients experience chronic disease. A minority of patients progress to a specific phenotype of sarcoidosis referred to advanced pulmonary sarcoidosis (APS) which includes advanced fibrosis, pulmonary hypertension and respiratory failure, leading to high morbidity and mortality. In patients with advanced disease despite medical therapy, lung transplantation may be the last viable option for improvement in quality of life. Though post-transplant survival is similar to that of other end-stage lung diseases, it is imperative that patients are evaluated and referred early to transplant centers with experience in APS. A multidisciplinary approach and clinical experience are crucial in detecting the optimal timing of referral, initiating comprehensive transplantation evaluation and listing, discussing surgical approach, and managing perioperative and post-transplant care. This review article seeks to address these aspects of lung transplantation in APS.
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Affiliation(s)
- Jin Sun Kim
- Lewis Katz School of Medicine, Department of Thoracic Medicine and Surgery, Philadelphia, PA, USA.
| | - Rohit Gupta
- Lewis Katz School of Medicine, Department of Thoracic Medicine and Surgery, Philadelphia, PA, USA
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Judson MA. The Symptoms of Pulmonary Sarcoidosis. J Clin Med 2023; 12:6088. [PMID: 37763028 PMCID: PMC10532418 DOI: 10.3390/jcm12186088] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 09/12/2023] [Accepted: 09/15/2023] [Indexed: 09/29/2023] Open
Abstract
The aim of this manuscript is to provide a comprehensive review of the etiology, measurement, and treatment of common pulmonary symptoms associated with sarcoidosis. The assessment of symptoms associated with pulmonary sarcoidosis is an important component of disease management. Some symptoms of pulmonary sarcoidosis are sensitive but nonspecific markers of disease activity, and the absence of such symptoms provides evidence that the disease is quiescent. Although quantifiable objective measurements of pulmonary physiology and chest imaging are important in the assessment of pulmonary sarcoidosis, they correlate poorly with the patient's quality of life. Because the symptoms of pulmonary sarcoidosis directly relate to how the patient feels, they are reasonable endpoints in terms of clinical research and individual patient care. Recently, the symptoms of pulmonary sarcoidosis are capable of being quantified via patient-reported outcome measures and electronic devices. We conclude that a thorough assessment of the symptoms associated with pulmonary sarcoidosis improves patient care because it is a useful screen for manifestations of the disease, provides insight into the pathophysiology of manifestations of sarcoidosis, and may assist in optimizing treatment.
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Affiliation(s)
- Marc A Judson
- Division of Pulmonary and Critical Care Medicine, Albany Medical College, Albany, NY 12208, USA
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Kahlmann V, Moor CC, van Helmondt SJ, Mostard RLM, van der Lee ML, Grutters JC, Wijsenbeek MS, Veltkamp M. Online mindfulness-based cognitive therapy for fatigue in patients with sarcoidosis (TIRED): a randomised controlled trial. THE LANCET. RESPIRATORY MEDICINE 2023; 11:265-272. [PMID: 36427515 DOI: 10.1016/s2213-2600(22)00387-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 09/16/2022] [Accepted: 09/16/2022] [Indexed: 11/24/2022]
Abstract
BACKGROUND Sarcoidosis-associated fatigue is highly prevalent and is often reported as the most burdensome symptom of sarcoidosis. Management of fatigue is challenging, and evidence-based therapies are lacking. In this TIRED trial, we aimed to assess the effects of a 12-week online mindfulness-based cognitive therapy (eMBCT) on fatigue. METHODS This study was a prospective, open-label, multicentre randomised controlled trial, conducted at three centres in the Netherlands. Eligible patients were 18 years or older, had stable sarcoidosis, and a score of more than 21 points on the Fatigue Assessment Scale (FAS). Patients were randomised into either the eMBCT or the control group. Participants completed patient-reported outcome measures at baseline, after intervention (T1), and 12 weeks after completion of eMBCT (T2). The primary outcome was the change in FAS score at T1 in the eMBCT group compared with the control group, assessed with the independent students't test in all patients who started the study. Secondary outcomes included within-group difference in FAS score at T1 and T2, between-group difference in FAS score at T2, and changes in the Hospital Anxiety and Depression Scale, the Freiburg Mindfulness Inventory-Short Form, and the Kings Sarcoidosis Questionnaire. The study was registered at the Netherlands Trial Register, NL7816. FINDINGS Between June 5, 2019, and Oct 28, 2021, 99 patients were randomly assigned to the eMBCT (n=52) or the control (n=47) groups. Six patients withdrew consent after psychological screening before the start of eMBCT. Baseline FAS score was similar in both groups (34·57 [SD 6·07] for 46 patients in the eMBCT group and 35·51 [4·65] for 47 patients in the control group). Mean change in FAS score at T1 was -4·53 (SD 5·77; p<0·0001) in the eMBCT group and -1·28 (3·80; p=0·026) in the control group (between-group difference 3·26 [95% CI 1·18 to 5·33; p=0·0025]). Furthermore, the eMBCT group had a significant improvement in anxiety (mean between-group difference 1·69, 95% CI 0·22-3·16; p=0·025), depressive symptoms (1·52, 0·08-2·95; p=0·039), mindfulness (3·1, 0·70-5·49; p=0·022), and general health status (6·28, 2·51-10·06; p=0·002) at T1, compared with the control group. INTERPRETATION 12 week eMBCT improves fatigue, anxiety, depression, mindfulness, and health status in patients with sarcoidosis-associated fatigue. FUNDING Dutch Sarcoidosis Patient Association (Sarcoidose.nl). TRANSLATION For the Dutch translation of the summary see Supplementary Materials section.
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Affiliation(s)
- Vivienne Kahlmann
- Center of Excellence for Interstitial Lung Diseases and Sarcoidosis, Department of Respiratory Medicine, Erasmus Medical Center-University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Catharina C Moor
- Center of Excellence for Interstitial Lung Diseases and Sarcoidosis, Department of Respiratory Medicine, Erasmus Medical Center-University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Sanne J van Helmondt
- ILD Center of Excellence, Department of Pulmonology, St Antonius Hospital, Nieuwegein, Netherlands
| | - Rémy L M Mostard
- Department of Respiratory Medicine, Zuyderland Medical Center, Heerlen, Netherlands; Department of Respiratory Medicine, Maastricht University Medical Center (MUMC+), Maastricht, Netherlands
| | - Marije L van der Lee
- Scientific Research Department, Helen Dowling Institute, Bilthoven, Netherlands; Department of Medical and Clinical Psychology, Center of Research on Psychology in Somatic diseases (CoRPS), Tilburg University, Tilburg, Netherlands
| | - Jan C Grutters
- ILD Center of Excellence, Department of Pulmonology, St Antonius Hospital, Nieuwegein, Netherlands; Division of Heart and Lungs, University Medical Center Utrecht, Utrecht, Netherlands
| | - Marlies S Wijsenbeek
- Center of Excellence for Interstitial Lung Diseases and Sarcoidosis, Department of Respiratory Medicine, Erasmus Medical Center-University Medical Center Rotterdam, Rotterdam, Netherlands.
| | - Marcel Veltkamp
- ILD Center of Excellence, Department of Pulmonology, St Antonius Hospital, Nieuwegein, Netherlands; Division of Heart and Lungs, University Medical Center Utrecht, Utrecht, Netherlands
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Abstract
INTRODUCTION Advanced pulmonary sarcoidosis refers to phenotypes of pulmonary sarcoidosis that often lead to significant loss of lung function, respiratory failure, or death. Around 20% of patients with sarcoidosis may progress to this state which is mainly driven by advanced pulmonary fibrosis. Advanced fibrosis often presents with associated complications of sarcoidosis including infections, bronchiectasis, and pulmonary hypertension. AREAS COVERED This article will focus on the pathogenesis, natural history of disease, diagnosis, and potential treatment options of pulmonary fibrosis in sarcoidosis. In the expert opinion section, we will discuss the prognosis and management of patients with significant disease. EXPERT OPINION While some patients with pulmonary sarcoidosis remain stable or improve with anti-inflammatory therapies, others develop pulmonary fibrosis and further complications. Although advanced pulmonary fibrosis is the leading cause of death in sarcoidosis, there are no evidence-based guidelines for the management of fibrotic sarcoidosis. Current recommendations are based on expert consensus and often include multidisciplinary discussions with experts in sarcoidosis, pulmonary hypertension, and lung transplantation to facilitate care for such complex patients. Current works evaluating treatments include the use of antifibrotic therapies for treatment in advanced pulmonary sarcoidosis.
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Affiliation(s)
- Rohit Gupta
- Thoracic Medicine and Surgery, Temple University Hospital, Philadelphia, PA, USA
| | - Jin Sun Kim
- Thoracic Medicine and Surgery, Temple University Hospital, Philadelphia, PA, USA
| | - Robert P Baughman
- Department of Medicine, University of Cincinnati, Cincinnati, Ohio, USA
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Obi ON, Saketkoo LA, Russell AM, Baughman RP. Sarcoidosis: Updates on therapeutic drug trials and novel treatment approaches. Front Med (Lausanne) 2022; 9:991783. [PMID: 36314034 PMCID: PMC9596775 DOI: 10.3389/fmed.2022.991783] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 08/17/2022] [Indexed: 12/04/2022] Open
Abstract
Sarcoidosis is a systemic granulomatous inflammatory disease of unknown etiology. It affects the lungs in over 90% of patients yet extra-pulmonary and multi-organ involvement is common. Spontaneous remission of disease occurs commonly, nonetheless, over 50% of patients will require treatment and up to 30% of patients will develop a chronic progressive non-remitting disease with marked pulmonary fibrosis leading to significant morbidity and death. Guidelines outlining an immunosuppressive treatment approach to sarcoidosis were recently published, however, the strength of evidence behind many of the guideline recommended drugs is weak. None of the drugs currently used for the treatment of sarcoidosis have been rigorously studied and prescription of these drugs is often based on off-label” indications informed by experience with other diseases. Indeed, only two medications [prednisone and repository corticotropin (RCI) injection] currently used in the treatment of sarcoidosis are approved by the United States Food and Drug Administration. This situation results in significant reimbursement challenges especially for the more advanced (and often more effective) drugs that are favored for severe and refractory forms of disease causing an over-reliance on corticosteroids known to be associated with significant dose and duration dependent toxicities. This past decade has seen a renewed interest in developing new drugs and exploring novel therapeutic pathways for the treatment of sarcoidosis. Several of these trials are active randomized controlled trials (RCTs) designed to recruit relatively large numbers of patients with a goal to determine the safety, efficacy, and tolerability of these new molecules and therapeutic approaches. While it is an exciting time, it is also necessary to exercise caution. Resources including research dollars and most importantly, patient populations available for trials are limited and thus necessitate that several of the challenges facing drug trials and drug development in sarcoidosis are addressed. This will ensure that currently available resources are judiciously utilized. Our paper reviews the ongoing and anticipated drug trials in sarcoidosis and addresses the challenges facing these and future trials. We also review several recently completed trials and draw lessons that should be applied in future.
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Affiliation(s)
- Ogugua Ndili Obi
- Division of Pulmonary Critical Care and Sleep Medicine, Brody School of Medicine, East Carolina University, Greenville, NC, United States,*Correspondence: Ogugua Ndili Obi,
| | - Lesley Ann Saketkoo
- New Orleans Scleroderma and Sarcoidosis Patient Care and Research Center, New Orleans, LA, United States,University Medical Center—Comprehensive Pulmonary Hypertension Center and Interstitial Lung Disease Clinic Programs, New Orleans, LA, United States,Section of Pulmonary Medicine, Louisiana State University School of Medicine, New Orleans, LA, United States,Department of Undergraduate Honors, Tulane University School of Medicine, New Orleans, LA, United States
| | - Anne-Marie Russell
- Exeter Respiratory Institute University of Exeter, Exeter, United Kingdom,Royal Devon and Exeter NHS Foundation Trust, Devon, United Kingdom,Faculty of Medicine, Imperial College and Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Robert P. Baughman
- Department of Medicine, University of Cincinnati, Cincinnati, OH, United States
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Morton‐Holtham L, Swann N, Brewer J, Moir HJ. A systematic review of physical activity and physical fitness in sarcoidosis. TRANSLATIONAL SPORTS MEDICINE 2021. [DOI: 10.1002/tsm2.278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- L. Morton‐Holtham
- Department of Applied & Human Sciences School of Life Sciences Pharmacy & Chemistry Kingston University London UK
| | - N. Swann
- Department of Applied & Human Sciences School of Life Sciences Pharmacy & Chemistry Kingston University London UK
- School of Biosciences and Medicine University of Surrey Guildford UK
| | | | - H. J. Moir
- Department of Applied & Human Sciences School of Life Sciences Pharmacy & Chemistry Kingston University London UK
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ERS clinical practice guidelines on treatment of sarcoidosis. Eur Respir J 2021; 58:13993003.04079-2020. [PMID: 34140301 DOI: 10.1183/13993003.04079-2020] [Citation(s) in RCA: 201] [Impact Index Per Article: 67.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 05/04/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND The major reasons to treat sarcoidosis are to lower the morbidity and mortality risk or to improve quality of life (QoL). The indication for treatment varies depending on which manifestation is the cause of symptoms: lungs, heart, brain, skin, or other manifestations. While glucocorticoids (GC) remain the first choice for initial treatment of symptomatic disease, prolonged use is associated with significant toxicity. GC-sparing alternatives are available. The presented treatment guideline aims to provide guidance to physicians treating the very heterogenous sarcoidosis manifestations. MATERIALS AND METHODS A European Respiratory Society Task Force (TF) committee composed of clinicians, methodologists, and patients with experience in sarcoidosis developed recommendations based on the GRADE (Grading of Recommendations, Assessment, Development and Evaluations) methodology. The committee developed eight PICO (Patients, Intervention, Comparison, Outcomes) questions and these were used to make specific evidence-based recommendations. RESULTS The TF committee delivered twelve recommendations for seven PICOs. These included treatment of pulmonary, cutaneous, cardiac, and neurologic disease as well as fatigue. One PICO question regarding small fiber neuropathy had insufficient evidence to support a recommendation. In addition to the recommendations, the committee provided information on how they use alternative treatments, when there was insufficient evidence to support a recommendation. CONCLUSIONS There are many treatments available to treat sarcoidosis. Given the diverse nature of the disease, treatment decisions require an assessment of organ involvement, risk for significant morbidity, and impact on QoL of the disease and treatment. MESSAGE An evidence based guideline for treatment of sarcoidosis is presented. The panel used the GRADE approach and specific recommendations are made. A major factor in treating patients is the risk of loss of organ function or impairment of quality of life.
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Saketkoo LA, Russell AM, Jensen K, Mandizha J, Tavee J, Newton J, Rivera F, Howie M, Reese R, Goodman M, Hart P, Strookappe B, De Vries J, Rosenbach M, Scholand MB, Lammi MR, Elfferich M, Lower E, Baughman RP, Sweiss N, Judson MA, Drent M. Health-Related Quality of Life (HRQoL) in Sarcoidosis: Diagnosis, Management, and Health Outcomes. Diagnostics (Basel) 2021; 11:1089. [PMID: 34203584 PMCID: PMC8232334 DOI: 10.3390/diagnostics11061089] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 05/30/2021] [Accepted: 06/02/2021] [Indexed: 02/06/2023] Open
Abstract
Health-related quality of life (HRQoL), though rarely considered as a primary endpoint in clinical trials, may be the single outcome reflective of patient priorities when living with a health condition. HRQoL is a multi-dimensional concept that reflects the degree to which a health condition interferes with participation in and fulfillment of important life areas. HRQoL is intended to capture the composite degree of physical, physiologic, psychological, and social impairment resulting from symptom burden, patient-perceived disease severity, and treatment side effects. Diminished HRQoL expectedly correlates to worsening disability and death; but interventions addressing HRQoL are linked to increased survival. Sarcoidosis, being a multi-organ system disease, is associated with a diffuse array of manifestations resulting in multiple symptoms, complications, and medication-related side effects that are linked to reduced HRQoL. Diminished HRQoL in sarcoidosis is related to decreased physical function, pain, significant loss of income, absence from work, and strain on personal relationships. Symptom distress can result clearly from a sarcoidosis manifestation (e.g., ocular pain, breathlessness, cough) but may also be non-specific, such as pain or fatigue. More complex, a single non-specific symptom, e.g., fatigue may be directly sarcoidosis-derived (e.g., inflammatory state, neurologic, hormonal, cardiopulmonary), medication-related (e.g., anemia, sleeplessness, weight gain, sub-clinical infection), or an indirect complication (e.g., sleep apnea, physical deconditioning, depression). Identifying and distinguishing underlying causes of impaired HRQoL provides opportunity for treatment strategies that can greatly impact a patient's function, well-being, and disease outcomes. Herein, we present a reference manual that describes the current state of knowledge in sarcoidosis-related HRQoL and distinguish between diverse causes of symptom distress and other influences on sarcoidosis-related HRQoL. We provide tools to assess, investigate, and diagnose compromised HRQoL and its influencers. Strategies to address modifiable HRQoL factors through palliation of symptoms and methods to improve the sarcoidosis health profile are outlined; as well as a proposed research agenda in sarcoidosis-related HRQoL.
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Affiliation(s)
- Lesley Ann Saketkoo
- New Orleans Scleroderma and Sarcoidosis Patient Care and Research Center, New Orleans, LA 70112, USA; (K.J.); (M.R.L.)
- Comprehensive Pulmonary Hypertension Center and Interstitial Lung Disease Clinic Programs, University Medical Center, New Orleans, LA 70112, USA
- Section of Pulmonary Medicine, Louisiana State University School of Medicine, New Orleans, LA 70112, USA
- Tulane University School of Medicine, Tulane University, New Orleans, LA 70112, USA
| | - Anne-Marie Russell
- College of Medicine and Health, University of Exeter, Devon EX1 2LU, UK
- Imperial College Healthcare NHS Foundation Trust, London W2 1NY, UK
| | - Kelly Jensen
- New Orleans Scleroderma and Sarcoidosis Patient Care and Research Center, New Orleans, LA 70112, USA; (K.J.); (M.R.L.)
- Tulane University School of Medicine, Tulane University, New Orleans, LA 70112, USA
- Department of Internal Medicine, Oregon Health and Science University, Portland, OR 97239, USA
| | - Jessica Mandizha
- Respiratory Medicine, Royal Devon and Exeter Hospital NHS Foundation Trust, Exeter EX2 5DW, UK;
| | - Jinny Tavee
- Department of Neurology, National Jewish Health, Denver, CO 80206, USA;
| | - Jacqui Newton
- Sarcoidosis UK, China Works, Black Prince Road, London SE1 7SJ, UK; (J.N.); (M.H.)
| | - Frank Rivera
- Foundation for Sarcoidosis Research, Chicago, IL 60614, USA; (F.R.); (R.R.)
- National Sarcoidosis Support Group, Stronger than Sarcoidosis, New York, NY 11727, USA
| | - Mike Howie
- Sarcoidosis UK, China Works, Black Prince Road, London SE1 7SJ, UK; (J.N.); (M.H.)
- CGI UK, Space Defense & Intelligence (Cyber Security Operations), London EC3M 3BY, UK
| | - Rodney Reese
- Foundation for Sarcoidosis Research, Chicago, IL 60614, USA; (F.R.); (R.R.)
- National Sarcoidosis Support Group, Stronger than Sarcoidosis, New York, NY 11727, USA
- Sarcoidosis Awareness Foundation of Louisiana, Baton Rouge, LA 70812, USA
| | - Melanie Goodman
- New Orleans Sarcoidosis Support Group, New Orleans, LA 70112, USA;
| | - Patricia Hart
- iHart Wellness Holistic Approach to Sarcoidosis Certified Health & Wellness Coach, International Association of Professionals, New York, NY 11727, USA;
| | - Bert Strookappe
- Department of Physiotherapy, Gelderse Vallei Hospital, 10, 6716 RP Ede, The Netherlands; (B.S.); (M.E.)
- ildcare Foundation Research Team, 6711 NR Ede, The Netherlands; (M.D.)
| | - Jolanda De Vries
- Admiraal de Ruyter Hospital (Adrz), 114, 4462 RA Goes, The Netherlands;
- Department of Medical and Clinical Psychology, Tilburg University, 5037 AB Tilburg, The Netherlands
| | - Misha Rosenbach
- Cutaneous Sarcoidosis Clinic, Department of Dermatology, University of Pennsylvania, Philadelphia, PA 19104, USA;
| | - Mary Beth Scholand
- Division of Pulmonary Medicine, Interstitial Lung Disease Center, University of Utah, Salt Lake City, UT 84132, USA;
| | - Mathew R. Lammi
- New Orleans Scleroderma and Sarcoidosis Patient Care and Research Center, New Orleans, LA 70112, USA; (K.J.); (M.R.L.)
- Comprehensive Pulmonary Hypertension Center and Interstitial Lung Disease Clinic Programs, University Medical Center, New Orleans, LA 70112, USA
- Section of Pulmonary Medicine, Louisiana State University School of Medicine, New Orleans, LA 70112, USA
| | - Marjon Elfferich
- Department of Physiotherapy, Gelderse Vallei Hospital, 10, 6716 RP Ede, The Netherlands; (B.S.); (M.E.)
- ildcare Foundation Research Team, 6711 NR Ede, The Netherlands; (M.D.)
| | - Elyse Lower
- Department of Medicine, University of Cincinnati Medical Center, Cincinnati, OH 45267, USA; (E.L.); (R.P.B.)
| | - Robert P. Baughman
- Department of Medicine, University of Cincinnati Medical Center, Cincinnati, OH 45267, USA; (E.L.); (R.P.B.)
| | - Nadera Sweiss
- Division of Rheumatology, Department of Medicine, University of Illinois at Chicago, Chicago, IL 60612, USA;
| | - Marc A. Judson
- Division of Pulmonary Medicine and Critical Care, Albany Medical College, Albany, NY 12208, USA;
| | - Marjolein Drent
- ildcare Foundation Research Team, 6711 NR Ede, The Netherlands; (M.D.)
- Interstitial Lung Diseases (ILD) Center of Excellence, Department of Pulmonology, St. Antonius Hospital, Koekoekslaan 1, 3435 CM Nieuwegein, The Netherlands
- Department of Pharmacology and Toxicology, Faculty of Health and Life Sciences, Maastricht University, 40, 6229 ER Maastricht, The Netherlands
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Crouser ED, Smith RM, Culver DA, Julian MW, Martin K, Baran J, Diaz C, Erdal BS, Hade EM. A Pilot Randomized Trial of Transdermal Nicotine for Pulmonary Sarcoidosis. Chest 2021; 160:1340-1349. [PMID: 34029565 DOI: 10.1016/j.chest.2021.05.031] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 04/16/2021] [Accepted: 05/07/2021] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Tobacco smoking is associated with a reduced risk of developing sarcoidosis, and we previously reported that nicotine normalizes immune responses to environmental antigens in patients with active pulmonary sarcoidosis. The effects of nicotine on the progression of pulmonary sarcoidosis are unknown. RESEARCH QUESTION Is nicotine treatment well tolerated, and will it improve lung function in patients with active pulmonary sarcoidosis? STUDY DESIGN AND METHODS With local institutional review board approval, a randomized, double-blind, controlled pilot trial was conducted of daily nicotine transdermal patch treatment (21 mg daily) or placebo patch use for 24 weeks. The Ohio State University Wexner Medical Center and Cleveland Clinic enrolled 50 consecutive adult subjects aged ≥ 18 years with active pulmonary sarcoidosis, based on symptoms (ie, dyspnea, cough) and objective radiographic evidence of infiltrates consistent with nonfibrotic lung disease. Each study group was compared at 26 weeks based on repeated measures of FVC, FEV1, quantitative lung texture score based on CT texture analysis, Fatigue Assessment Score (FAS), St. George's Respiratory Questionnaire (SGRQ), and the Sarcoidosis Assessment Tool. RESULTS Nicotine treatment was associated with a clinically significant, approximately 2.1% (70 mL) improvement in FVC from baseline to 26 weeks. FVC decreased by a similar amount (2.2%) in the placebo group, with a net increase of 140 mL (95% CI, 10-260) when comparing nicotine vs placebo groups at 26 weeks. FEV1 and FAS improved marginally in the nicotine-treated group, compared with those on placebo. No improvement was observed in lung texture score, FAS, St. George's Respiratory Questionnaire score, or the Sarcoidosis Assessment Tool. There were no reported serious adverse events or evidence of nicotine addiction. INTERPRETATION Nicotine treatment was well tolerated in patients with active pulmonary sarcoidosis, and the preliminary findings of this pilot study suggest that it may reduce disease progression, based on FVC. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov; No.: NCT02265874; URL: www.clinicaltrials.gov.
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Affiliation(s)
- Elliott D Crouser
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Internal Medicine, The Ohio State University, Columbus, OH.
| | - Rachel M Smith
- Center for Biostatistics, Department of Biomedical Informatics, The Ohio State University, Columbus, OH
| | - Daniel A Culver
- Department of Pulmonary Medicine, Respiratory Institute, Cleveland Clinic, Cleveland, OH
| | - Mark W Julian
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Internal Medicine, The Ohio State University, Columbus, OH
| | - Karen Martin
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Internal Medicine, The Ohio State University, Columbus, OH
| | - Joanne Baran
- Department of Pulmonary Medicine, Respiratory Institute, Cleveland Clinic, Cleveland, OH
| | | | | | - Erinn M Hade
- Department of Pulmonary Medicine, Respiratory Institute, Cleveland Clinic, Cleveland, OH; Division of Biostatistics, Department of Population Health, New York University Grossman School of Medicine, New York, NY
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13
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Guber E, Wand O, Epstein Shochet G, Romem A, Shitrit D. The Short- and Long-Term Impact of Pulmonary Rehabilitation in Subjects with Sarcoidosis: A Prospective Study and Review of the Literature. Respiration 2021; 100:423-431. [PMID: 33784708 DOI: 10.1159/000514917] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Accepted: 01/29/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Sarcoidosis is a heterogeneous multisystemic disorder of unknown etiology. Dyspnea and fatigue are two of the most common and debilitating symptoms experienced by subjects with sarcoidosis. There is limited evidence regarding the short- and long-term impact of pulmonary rehabilitation (PR) on exercise capacity and fatigue in these individuals. OBJECTIVE To evaluate the benefit of PR in subjects with pulmonary sarcoidosis at different severity stages and to review the current literature about PR in sarcoidosis. METHODS PR included a 12-week training program of a twice-weekly 90-min workouts. Fifty-two subjects with stable pulmonary sarcoidosis were recruited. Maximal exercise capacity, defined as VO2max, was measured using the cardiopulmonary exercise test (CPET). Pulmonary function tests, 6-min walking distance (6MWD), St. George's Respiratory Questionnaire (SGRQ), and the modified Medical Research Council (mMRC) and Hospital Anxiety and Depression Scale (HADS) questionnaires were given before and after PR and following 6 months (follow-up). RESULTS The PR program significantly increased the VO2max (1.8 ± 2.3 mL/kg/min, p = 0.002), following 12 weeks. mMRC and SGRQ scores were also improved (-0.3 ± 0.8, p = 0.03, and -3.87 ± 10.4, p = 0.03, respectively). The impact of PR on VO2max was more pronounced in subjects with pulmonary parenchymal involvement. The increase in VO2max correlated with initial disease severity (indicated by FEV1/FVC, p = 0.01). Subjects with FEV1/FVC <70% showed greater improvement in 6MWD. 6MWD also improved in those with a transfer coefficient of the lung for CO (KCO) above 80% predicted (p < 0.05). At 6-month follow-up, the VO2max, 6MWD, and SGRQ scores remained stable, thus suggesting lasting effects of PR. CONCLUSION PR is a promising complementary therapeutic intervention for subjects with sarcoidosis. Further study is needed to validate these findings.
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Affiliation(s)
- Elad Guber
- Pulmonary Department, Meir Medical Center, Kfar Saba, Israel
| | - Ori Wand
- Pulmonary Department, Meir Medical Center, Kfar Saba, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Gali Epstein Shochet
- Pulmonary Department, Meir Medical Center, Kfar Saba, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ayal Romem
- Pulmonary Department, Meir Medical Center, Kfar Saba, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - David Shitrit
- Pulmonary Department, Meir Medical Center, Kfar Saba, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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14
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Jastrzebski D, Toczylowska B, Zieminska E, Zebrowska A, Kostorz-Nosal S, Swietochowska E, Di Giulio C, Ziora D. The effects of exercise training on lipid profile in patients with sarcoidosis. Sci Rep 2021; 11:5551. [PMID: 33692469 PMCID: PMC7946908 DOI: 10.1038/s41598-021-84815-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Accepted: 02/17/2021] [Indexed: 12/20/2022] Open
Abstract
This study aimed to determine the use of lipid profiling to assess the effects of moderate intensity exercise training (ET) on patients with sarcoidosis. Fourteen patients with sarcoidosis (mean age, 46.0 ± 9.6 years) were examined before and after 3-week of ET programme in hospital settings. Symptoms (fatigue: FAS, dyspnoea: MRC), lung function tests and physical function tests (6 MWT, muscle force) were measured before and after ET. Proton nuclear magnetic resonance (NMR) spectroscopy combined with orthogonal partial least squares-discriminant analysis (OPLS-DA) was used to determine lipid profile before and after ET. Twenty-five NMR signals from lipid compounds were selected for further analysis as well as serum lipid and inflammatory markers. Three weeks of ET results in improvement of symptoms (FAS: 27.5 vs. 21.0; p < 0.001, MRC: 0.86 vs. 0.14; p = 0.002) and physical function (6MWT: 508.43 vs. 547.29; p = 0.039). OPLS-DA analysis of the lipid profiles of patients with sarcoidosis revealed differences among the samples before and after ET, including decreases in fatty acids (p < 0.017), triglycerides (p < 0.022) and total cholesterol (p < 0.020). Other changes included shifts in fatty acids oxidation products and triacylglycerol esters. A short-time, in-hospital exercise training benefits patients with sarcoidosis by enhancing their physical function. Additionally, positive effect on lipid profile was observed also in this study. It is suggested that lipid profiling could become a new prognostic method to assess effects of pulmonary rehabilitation in patients with sarcoidosis.
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Affiliation(s)
- Dariusz Jastrzebski
- Department of Lung Diseases and Tuberculosis, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, 41-800, Zabrze, Poland.
| | - Beata Toczylowska
- Nalecz Institute of Biocybernetics and Biomedical Engineering, Polish Academy of Sciences, 02-109, Warsaw, Poland
| | - Elzbieta Zieminska
- Mossakowski Medical Research Centre, Polish Academy of Sciences, 02-106, Warsaw, Poland
| | - Aleksandra Zebrowska
- Institute of Sport Sciences, Department of Physiological and Medical Sciences, Academy of Physical Education, 40-065, Katowice, Poland
| | - Sabina Kostorz-Nosal
- Department of Lung Diseases and Tuberculosis, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, 41-800, Zabrze, Poland
| | - Elzbieta Swietochowska
- Department of Medical and Molecular Biology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, 41-808, Zabrze, Poland
| | - Camillo Di Giulio
- Department of Neuroscience and Imaging, University of Chieti-Pescara, Via dei Vestini 31, 66100, Chieti, Italy
| | - Dariusz Ziora
- Department of Lung Diseases and Tuberculosis, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, 41-800, Zabrze, Poland
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15
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Herrera-Olivares AM, García-Manso JM, Rodríguez-Gómez I, Ara I, Lucia A, Santalla A. Long-Term Benefits of Tailored Exercise in Severe Sarcoidosis: A Case Report. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E9512. [PMID: 33353138 PMCID: PMC7766182 DOI: 10.3390/ijerph17249512] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Revised: 12/04/2020] [Accepted: 12/12/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND We studied the effects of a supervised, structured exercise program in a severe sarcoidosis patient. METHODS After being clinically stable for two years, a 52-year-old woman (stage IV, American Thoracic Society) who originally had irreversible lung fibrosis, pulmonary arterial hypertension (PAH), mild mitral insufficiency, and atrial dilatation, and was candidate for lung transplant, performed a combined high-intensity interval, high load resistance, and inspiratory muscle training for 4.5 years, and was tested (cardiopulmonary exercise testing and dual X-ray absorptiometry) every six months. RESULTS Cardiorespiratory fitness (CRF) and maximal pulmonary ventilation increased by 44% and 60%, respectively. Ventilatory efficiency also improved (decrease in the ventilatory equivalent for oxygen by 32% and 14% at the ventilatory threshold and respiratory compensation point, respectively). She improved New York Heart Association (NYHA) class (from III to II), and cardiac alterations as well as PAH reversed so that she was not in need of lung transplantation anymore. Likewise, she suffered no more episodes of hemoptysis. Bone health was overall maintained despite the post-menopausal status and the corticoid treatment. CONCLUSIONS A long-term combined exercise intervention safely contributed-at least partly-to improve CRF and NYHA class in a patient with severe sarcoidosis, suggesting a potential coadjuvant effect to attenuate clinical manifestations.
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Affiliation(s)
| | | | - Irene Rodríguez-Gómez
- GENUD Toledo Research Group, Universidad de Castilla-La Mancha, 45004 Toledo, Spain; (I.R.-G.); (I.A.)
- CIBER of Frailty and Healthy Aging (CIBERFES), 28029 Madrid, Spain
| | - Ignacio Ara
- GENUD Toledo Research Group, Universidad de Castilla-La Mancha, 45004 Toledo, Spain; (I.R.-G.); (I.A.)
- CIBER of Frailty and Healthy Aging (CIBERFES), 28029 Madrid, Spain
| | - Alejandro Lucia
- Faculty of Sport Sciences, Universidad Europea de Madrid, 18670 Madrid, Spain;
- CIBER of Frailty and Healthy Aging (CIBERFES), 28029 Madrid, Spain
- Instituto de Investigación Hospital 12 de Octubre (imas12), 28041 Madrid, Spain;
| | - Alfredo Santalla
- Instituto de Investigación Hospital 12 de Octubre (imas12), 28041 Madrid, Spain;
- Faculty of Sport Sciences, Universidad Pablo de Olavide, 41013 Seville, Spain
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16
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Abstract
Sarcoidosis is a systemic disease of unknown etiology defined by the presence of noncaseating granulomatous inflammation that can cause organ damage and diminished quality of life. Treatment is indicated to protect organ function and decrease symptomatic burden. Current treatment options focus on interruption of granuloma formation and propagation. Clinical trials guiding evidence for treatment are lacking due to the rarity of disease, heterogeneous clinical course, and lack of prognostic biomarkers, all of which contribute to difficulty in clinical trial design and implementation. In this review, a multidisciplinary treatment approach is summarized, addressing immunuosuppressive drugs, managing complications of chronic granulomatous inflammation, and assessing treatment toxicity. Discovery of new therapies will depend on research into pathogenesis of antigen presentation and granulomatous inflammation. Future treatment approaches may also include personalized decisions based on pharmacogenomics and sarcoidosis phenotype, as well as patient-centered approaches to manage immunosuppression, symptom control, and treatment of comorbid conditions.
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Affiliation(s)
- Alicia K. Gerke
- Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Iowa, Iowa City, IA, United States
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17
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Drent M, Elfferich M, Breedveld E, Vries JD, Strookappe B. Benefit of Wearing an Activity Tracker in Sarcoidosis. J Pers Med 2020; 10:jpm10030097. [PMID: 32842583 PMCID: PMC7563218 DOI: 10.3390/jpm10030097] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 08/17/2020] [Accepted: 08/20/2020] [Indexed: 12/14/2022] Open
Abstract
Sarcoidosis causes many disabling symptoms, including fatigue and exercise limitations, which have been shown to improve by physical activity programs. The aim of this study was to estimate the effect of continuous activity monitoring using an electronic activity tracker (AT) on exercise performance and fatigue of sarcoidosis patients, compared to controls (cohort study), and the effect of additional personal coaching (randomized trial) over a period of 3 months. Fifty-four sarcoidosis patients received an AT (Group Ia: 27 with coaching and Group Ib: 27 without). A historical group of sarcoidosis patients (Group II; n = 41) who did not follow a physical activity program served as controls. Exercise performance of patients wearing an AT (Group I) improved compared with controls (Group II), including the 6MWD, % predicted (∆4.4 ± 9.1 versus ∆0.7 ± 5.0, respectively), and fatigue levels decreased (∆−3.9 ± 5.7 versus ∆−1.8 ± 5.3). Patients with coaching (Group Ia) showed greater improvement of exercise capacity over time than patients without coaching (Group Ib) as shown by the Steep Ramp Test results (watts: ∆20.2 ± 33.8 versus ∆5.7 ± 26.4; and SRT, VO2max, % predicted: ∆1.6 ± 2.6 versus ∆0.7 ± 2.3). Sarcoidosis patients wearing an AT achieved improvement of exercise performance and reduction of fatigue. We therefore recommend encouraging sarcoidosis patients to wear an AT to stimulate physical activity and reduce fatigue. The additional benefit of coaching needs to be explored in future studies.
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Affiliation(s)
- Marjolein Drent
- ILD Care Foundation Research Team, 6711 NR Ede, The Netherlands; (M.E.); (E.B.); (J.D.V.); (B.S.)
- ILD Center of Excellence, Department of Pulmonology, St. Antonius Hospital, 3435 CM Nieuwegein, The Netherlands
- Department of Pharmacology and Toxicology, FHML, University Maastricht, 6211 LK Maastricht, The Netherlands
- Correspondence: ; Tel.: +31-620449319
| | - Marjon Elfferich
- ILD Care Foundation Research Team, 6711 NR Ede, The Netherlands; (M.E.); (E.B.); (J.D.V.); (B.S.)
- Department of Physical Therapy, Hospital Gelderse Vallei, 6716 RP Ede, The Netherlands
| | - Ellen Breedveld
- ILD Care Foundation Research Team, 6711 NR Ede, The Netherlands; (M.E.); (E.B.); (J.D.V.); (B.S.)
- Department of Physical Therapy, Hospital Gelderse Vallei, 6716 RP Ede, The Netherlands
| | - Jolanda De Vries
- ILD Care Foundation Research Team, 6711 NR Ede, The Netherlands; (M.E.); (E.B.); (J.D.V.); (B.S.)
- Department of Medical Psychology, Elisabeth-TweeSteden Hospital Tilburg, 5042 AD Tilburg, The Netherlands
- Department of Medical and Clinical Psychology, Tilburg University, 5037 AB Tilburg, The Netherlands
| | - Bert Strookappe
- ILD Care Foundation Research Team, 6711 NR Ede, The Netherlands; (M.E.); (E.B.); (J.D.V.); (B.S.)
- Department of Physical Therapy, Hospital Gelderse Vallei, 6716 RP Ede, The Netherlands
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18
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Voortman M, Stern BJ, Saketkoo LA, Drent M. The Burden of Neurosarcoidosis: Essential Approaches to Early Diagnosis and Treatment. Semin Respir Crit Care Med 2020; 41:641-651. [PMID: 32777849 DOI: 10.1055/s-0040-1710576] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Neurosarcoidosis (NS) is an often severe, destructive manifestation with a likely under-reported prevalence of 5 to 15% of sarcoidosis cases, and in its active phase demands timely treatment intervention. Clinical signs and symptoms of NS are variable and wide-ranging, depending on anatomical involvement. Cranial nerve dysfunction, cerebrospinal parenchymal disease, aseptic meningitis, and leptomeningeal disease are the most commonly recognized manifestations. However, non-organ-specific potentially neurologically driven symptoms, such as fatigue, cognitive dysfunction, and small fiber neuropathy, appear frequently.Heterogeneous clinical presentations and absence of any single conclusive test or biomarker render NS, and sarcoidosis itself, a challenging definitive diagnosis. Clinical suspicion of NS warrants a thorough systemic and neurologic evaluation hopefully resulting in supportive extraneural physical exam and/or tissue findings. Treatment targets the severity of the manifestation, with careful discernment of whether NS reflects active potentially reversible inflammatory granulomatous disease versus inactive postinflammatory damage whereby functional impairment is unlikely to be pharmacologically responsive. Non-organ-specific symptoms are poorly understood, challenging in deciphering reversibility and often identified too late to respond to conventional immunosuppressive/pharmacological treatment. Physical therapy, coping strategies, and stress reduction may benefit patients with all disease activity levels of NS.This publication provides an approach to screening, diagnosis, disease activity discernment, and pharmacological as well as nonpharmacological treatment interventions to reduce disability and protect health-related quality of life in NS.
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Affiliation(s)
- Mareye Voortman
- Division of Heart and Lungs, Department of Pulmonology, University Medical Centre Utrecht, The Netherlands.,ILD Care Foundation Research Team, Ede, The Netherlands
| | - Barney J Stern
- Department of Neurology, Johns Hopkins University, Baltimore, Maryland
| | - Lesley Ann Saketkoo
- New Orleans Scleroderma and Sarcoidosis Patient Care and Research Center, New Orleans, Louisiana.,Comprehensive Pulmonary Hypertension Center and Interstitial Lung Disease Clinic Programs, University Medical Center, New Orleans, Louisiana.,Louisiana State University and Tulane University Schools of Medicine, New Orleans, Louisiana
| | - Marjolein Drent
- ILD Care Foundation Research Team, Ede, The Netherlands.,Department of Pharmacology and Toxicology, FHML, Maastricht University, Maastricht, The Netherlands.,Department of Pulmonology, ILD Center of Excellence, St. Antonius Hospital, Nieuwegein, The Netherlands
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19
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Abstract
As sarcoidosis may involve any organ, sarcoidosis patients should be evaluated for occult disease. Screening for some organ involvement may not be warranted if it is unlikely to cause symptoms, organ dysfunction, or affect clinical outcome. Even organ involvement that affects clinical outcome does not necessarily require screening if early detection fails to change the patient's quality of life or prognosis. On the other hand, early detection of some forms of sarcoidosis may improve outcomes and survival. This manuscript describes the approach to screening sarcoidosis patients for previously undetected disease. Screening for sarcoidosis should commence with a meticulous medical history and physical examination. Many sarcoidosis patients present with physical signs or symptoms of sarcoidosis that have not been recognized as manifestations of the disease. Detection of sarcoidosis in these instances depends on the clinician's familiarity with the varied clinical presentations of sarcoidosis. In addition, sarcoidosis patients may present with symptoms or signs that are not related to specific organ involvement that have been described as parasarcoidosis syndromes. It is conjectured that parasarcoidosis syndromes result from systemic release of inflammatory mediators from the sarcoidosis granuloma. Certain forms of sarcoidosis may cause permanent and serious problems that can be prevented if they are detected early in the course of their disease. These include (1) ocular involvement that may lead to permanent vision impairment; (2) vitamin D dysregulation that may lead to hypercalcemia, nephrolithiasis, and permanent kidney injury; and (3) cardiac sarcoidosis that may lead to a cardiomyopathy, ventricular arrhythmias, heart block, and sudden death. Screening for these forms of organ involvement requires detailed screening approaches.
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Affiliation(s)
- Marc A Judson
- Division of Pulmonary and Critical Care Medicine, Albany Medical College, Albany, New York
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20
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Grongstad A, Spruit MA, Oldervoll LM, Vøllestad NK, Edvardsen A. Pulmonary Rehabilitation in Patients with Pulmonary Sarcoidosis: Impact on Exercise Capacity and Fatigue. Respiration 2020; 99:289-297. [PMID: 32131065 DOI: 10.1159/000506295] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2019] [Accepted: 01/29/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND There is limited evidence regarding the impact of multidisciplinary pulmonary rehabilitation (PR) on exercise capacity and fatigue in patients with pulmonary sarcoidosis. The aim of this study was to evaluate the impact on exercise capacity and fatigue following PR, and to examine whether baseline fatigue was related to change in peak oxygen uptake (ΔV̇O2peak). METHODS Forty-one patients with pulmonary sarcoidosis attending a 4-week inpatient PR program were recruited to this pre-post study. Both maximal exercise capacity, defined as V̇O2peak and measured with a cardiopulmonary exercise test, and fatigue, assessed with the Fatigue Assessment Scale (score 10-50 points), were measured before and after PR. RESULTS There was a statistically significant improvement in V̇O2peak (1.2 ± 2.3 mL/kg/min, p = 0.002), and fatigue decreased significantly (-1.7 ± 3.9 points, p = 0.009) following PR. Unadjusted linear regression analyses demonstrated that age (B = -0.076, p = 0.017) and baseline fatigue (B = 0.196, p = 0.001) were predictors for change in V̇O2peak, while in adjusted analyses (age, sex, baseline V̇O2peak, baseline fatigue, and diffusion capacity of the lung for carbon monoxide), only baseline fatigue predicted change in V̇O2peak following PR (B = 0.165, p = 0.026). CONCLUSION A 4-week multidisciplinary PR program improves maximal exercise capacity and reduces fatigue in patients with pulmonary sarcoidosis. Baseline fatigue only partly predicted change in V̇O2peak following PR.
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Affiliation(s)
- Anita Grongstad
- LHL Hospital Gardermoen, Jessheim, Norway, .,Department of Interdisciplinary Health Sciences, University of Oslo, Oslo, Norway,
| | - Martijn A Spruit
- Department of Research and Development, CIRO, Horn, The Netherlands.,Department of Respiratory Medicine, Maastricht University Medical Centre, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht, The Netherlands.,REVAL Rehabilitation Research Center, BIOMED Biomedical Research Institute, Faculty of Rehabilitation Sciences, Hasselt University, Diepenbeek, Belgium
| | - Line Merethe Oldervoll
- LHL Clinics, Trondheim, Norway.,Department of Public Health and Nursing, Norwegian University of Technology and Science, Trondheim, Norway
| | - Nina Køpke Vøllestad
- Department of Interdisciplinary Health Sciences, University of Oslo, Oslo, Norway
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21
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Kullberg S, Rivera NV, Eriksson MJ, Grunewald J, Eklund A. High-intensity resistance training in newly diagnosed sarcoidosis- an exploratory study of effects on lung function, muscle strength, fatigue, dyspnea, health-related quality of life and lung immune cells. Eur Clin Respir J 2020; 7:1730137. [PMID: 32158524 PMCID: PMC7048202 DOI: 10.1080/20018525.2020.1730137] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Accepted: 02/10/2020] [Indexed: 01/07/2023] Open
Abstract
Background: High-intensity resistance training is unexplored in untreated patients with newly diagnosed sarcoidosis. Objectives: To evaluate the effects of high-intensity resistance training on lung function, muscle strength, fatigue, dyspnea, health-related impairments, and lung immune cells. Methods: Eleven untreated patients with newly diagnosed sarcoidosis performed high-intensity resistance training at an intensity of 80% of 1 Repetition Maximum (RM) twice a week and daily inspiratory muscle training at regular intensity for 12 weeks. Assessment with spirometry, chest X-ray, questionnaires, and BAL (bronchoalveolar lavage) cells was performed before and in close adjacent to completed training. A final third assessment except bronchoscopy was performed at an average 5 months after the training period. Results: The training was well tolerated and muscular strength increased significantly while fatigue, dyspnea, and health-related impairments decreased, though not significantly in all measures. Mean percentage of lung lymphocytes decreased (p = 0.006). Conclusions: High-intensity resistance training and inspiratory muscle training at regular intensity in patients with newly diagnosed sarcoidosis led to improvements in muscular strength without adverse events and seems to be a non-invasive attractive way to improve fatigue, dyspnea, and quality of life. Analysis of lung immune cells possibly indicated a decreased inflammatory activity. These results provide a basis for larger randomized trials.
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Affiliation(s)
- Susanna Kullberg
- Department of Respiratory Medicine, Karolinska University Hospital, Stockholm, Sweden.,Respiratory Medicine Division, Department of Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Natalia V Rivera
- Respiratory Medicine Division, Department of Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Maria J Eriksson
- Department of Clinical Physiology, Karolinska University Hospital, Stockholm, Sweden.,Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Johan Grunewald
- Department of Respiratory Medicine, Karolinska University Hospital, Stockholm, Sweden.,Respiratory Medicine Division, Department of Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Anders Eklund
- Department of Respiratory Medicine, Karolinska University Hospital, Stockholm, Sweden.,Respiratory Medicine Division, Department of Medicine, Karolinska Institutet, Stockholm, Sweden
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22
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Moor CC, Kahlmann V, Culver DA, Wijsenbeek MS. Comprehensive Care for Patients with Sarcoidosis. J Clin Med 2020; 9:E390. [PMID: 32024123 PMCID: PMC7074229 DOI: 10.3390/jcm9020390] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Revised: 01/21/2020] [Accepted: 01/29/2020] [Indexed: 02/07/2023] Open
Abstract
Sarcoidosis is a multisystem granulomatous disease, associated with significant morbidity and impaired quality of life. Treatment is aimed at recovering organ function, reducing symptom burden and improving quality of life. Because of the heterogeneity and variable disease course, a comprehensive, multidisciplinary approach to care is needed. Comprehensive care includes not only pharmacological interventions, but also supportive measures aimed at relieving symptoms and improving quality of life. The purpose of this review is to summarize the most recent knowledge regarding different aspects of care and propose a structured approach to sarcoidosis management.
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Affiliation(s)
- Catharina C. Moor
- Department of Respiratory Medicine, Erasmus Medical Center Rotterdam, 3015 GD Rotterdam, The Netherlands
| | - Vivienne Kahlmann
- Department of Respiratory Medicine, Erasmus Medical Center Rotterdam, 3015 GD Rotterdam, The Netherlands
| | - Daniel A. Culver
- Department of Pulmonary Medicine, Respiratory Institute, Cleveland Clinic, Cleveland, OH 44195, USA
| | - Marlies S. Wijsenbeek
- Department of Respiratory Medicine, Erasmus Medical Center Rotterdam, 3015 GD Rotterdam, The Netherlands
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23
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Abstract
Introduction: The treatment of pulmonary sarcoidosis is not standardized. Treatment involves a multi-step decision process beginning with whether treatment is warranted, determining initial therapy, then assessing when therapy requires modifications or can be discontinued.Areas covered: This manuscript will address the following issues concerning the treatment of pulmonary sarcoidosis: Treatment indications, initial anti-granulomatous therapy, therapy for chronic and fibrotic disease, glucocorticoid therapy, alternative therapy to glucocorticoids, non-granulomatous therapies, and managing complications of disease. Information was obtained through a literature search of PubMed and Web of Science databases.Expert opinion: Although glucocorticoids are highly effective for pulmonary sarcoidosis, their potential to cause significant side effects often mandates consideration of alternative agents. As the most common indication for the treatment of pulmonary sarcoidosis is quality of life impairment, traditional objective tests of lung function and radiographic imagining often have a minor role in therapeutic decision-making. The development of pulmonary fibrosis from sarcoidosis often causes major morbidity and mortality and should be a major focus of concern.
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Affiliation(s)
- W Ennis James
- Division of Pulmonary and Critical Care Medicine; Program Director, Susan Pearlstine Sarcoidosis Center of Excellence, Medical University of South Carolina, Charleston, SC, USA
| | - Marc A Judson
- Division of Pulmonary and Critical Care Medicine, Albany Medical College MC-91, Albany, NY, USA
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Grongstad A, Vøllestad NK, Oldervoll LM, Spruit MA, Edvardsen A. The acute impact of resistance training on fatigue in patients with pulmonary sarcoidosis. Chron Respir Dis 2020; 17:1479973120967024. [PMID: 33820449 PMCID: PMC7716061 DOI: 10.1177/1479973120967024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Fatigue is the most prevalent symptom among patients with sarcoidosis, and skeletal muscle dysfunction is a common clinical feature, making resistance training (RT) a recommended treatment strategy. Despite lacking knowledge regarding whether high-intensity RT will aggravate fatigue, low to moderate-intensity is routinely used even if the evidence for this protocol to improve muscle strength is inconclusive. This study aimed to investigate whether one single session of high-intensity RT induces a higher increase in fatigue than one single session of moderate-intensity RT. In this randomized crossover study, 41 patients with pulmonary sarcoidosis (age: 53 ± 11 yr) were recruited. They randomly performed one single session of high-intensity RT, 4 sets × 5 repetitions maximum (5RM), and one single session of moderate-intensity RT, 2 sets × 25 RM. Fatigue was assessed with the Visual Analogue Scale (0–100 mm) immediately before (T0), immediately after (T1) and 24 hours after (T2) each exercise session. Fatigue development from T0 to T1 was significantly lower after 5RM (−3 ± 18 mm) than after 25RM (5 ± 15 mm), p = 0.004. No difference was seen from T0 to T2 between 5RM (0 ± 17 mm) and 25RM (6 ± 18 mm), p = 0.147. The high-intensity 5RM session did not induce a larger increase in fatigue than the moderate-intensity 25RM session. RT appears feasible and safe in patients with pulmonary sarcoidosis irrespective of the intensity. Thus, the long-term effects of high-intensity RT on fatigue should be explored in a RT programme of longer duration.
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Affiliation(s)
- Anita Grongstad
- LHL Hospital Gardermoen, Jessheim, Norway.,Department of Interdisciplinary Health Sciences, University of Oslo, Oslo, Norway
| | - Nina Køpke Vøllestad
- Department of Interdisciplinary Health Sciences, University of Oslo, Oslo, Norway
| | - Line Merethe Oldervoll
- LHL Clinics, Trondheim, Norway.,Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Technology and Science (NTNU), Trondheim, Norway
| | - Martijn Arthur Spruit
- Department of Research & Development, CIRO, Horn, The Netherlands.,Department of Respiratory Medicine, Maastricht University Medical Centre, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht, The Netherlands.,REVAL-Rehabilitation Research Center, BIOMED-Biomedical Research Institute, Faculty of Rehabilitation Sciences, Hasselt University, Diepenbeek, Belgium
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Wallaert B, Kyheng M, Labreuche J, Stelianides S, Wemeau L, Grosbois JM. Long-term effects of pulmonary rehabilitation on daily life physical activity of patients with stage IV sarcoidosis: A randomized controlled trial. Respir Med Res 2019; 77:1-7. [PMID: 31855785 DOI: 10.1016/j.resmer.2019.10.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2019] [Revised: 10/05/2019] [Accepted: 10/19/2019] [Indexed: 12/23/2022]
Abstract
INTRODUCTION Pulmonary rehabilitation (PR) is known to improve exercise tolerance, mood, and quality of life in patients with chronic respiratory diseases. The aim of this work was to determine whether PR provides long-term benefits in increasing daily life physical activity in patients with chronic sarcoidosis. METHODS This randomized prospective study (registered ClinicalTrials.gov NCT02044939) of 38 patients with stage IV chronic sarcoidosis was performed between 2012 and 2016. Patients were assigned to participate in a 2-month PR program (n=20) or receive counseling (n=18). Assessments were performed at baseline, 2 months (end of the PR program), 6months, and 12months, and included daily life physical activity parameters (measured for 5 consecutive days), exercise tolerance, dyspnea, anxiety, depression, fatigue, and quality of life. The primary outcome was the 12-month change in time spent in activities above an estimated energy expenditure of 2.5metabolic equivalents (METs). Secondary daily life physical activity outcomes included number of steps per day, total daily energy expenditure, and total energy expenditure above 2.5METs. RESULTS The primary outcome did not differ between the two groups; mean between-group differences were -13.2min (95% confidence interval [CI]: -76.3 to 49.8) at 6 months and -18.1min (95% CI: -55.7 to 19.4) at 12months. Although PR had no effect on secondary daily life physical activity outcomes, it did significantly increase exercise tolerance at 6 and 12 months and decrease the dyspnea score at 6 months and the fatigue score at 12months. CONCLUSION This trial failed to demonstrate a beneficial effect of PR on daily life physical activity in sarcoidosis patients, suggesting that long-term behavioral programs may be necessary to complement PR.
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Affiliation(s)
- B Wallaert
- CHU Lille, Service de Pneumologie et ImmunoAllergologie, Centre de Référence constitutif des Maladies Rares, Hôpital Calmette, 59037 Lille, France; University of Lille, 59000 Lille, France.
| | - M Kyheng
- University of Lille, CHU Lille, EA 2694-Santé publique: épidémiologie et qualité des soins, Department of Biostatistics, 59000 Lille, France
| | - J Labreuche
- University of Lille, CHU Lille, EA 2694-Santé publique: épidémiologie et qualité des soins, Department of Biostatistics, 59000 Lille, France
| | - S Stelianides
- Division of Pneumology, Bichat Hospital, Paris-Diderot University, 75877, Paris, France
| | - L Wemeau
- CHU Lille, Service de Pneumologie et ImmunoAllergologie, Centre de Référence constitutif des Maladies Rares, Hôpital Calmette, 59037 Lille, France
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Abstract
PURPOSE OF REVIEW The current review discusses the diagnosis and management of nonorgan-related symptoms that commonly arise in the setting of systemic sarcoidosis. Fatigue, small fiber neuropathy (SFN) and neuropsychological symptoms are highlighted. RECENT FINDINGS The debilitating effects of chronic nonorgan-based symptoms in sarcoidosis have led to recent studies focusing on incidence rates, contributing factors and potential therapeutic strategies. In a web-based survey of over 1000 sarcoidosis patients, the most common symptom was fatigue, which was reported by over 90% of participants, whereas memory loss and concentration problems were reported in 50%. SFN was also common, and may be diagnosed with tools such as skin biopsy measurement of intraepidermal nerve fibers and corneal confocal microscopy. In a recent cohort study of SFN patients, serologic evaluation demonstrated other contributing causes such as diabetes and vitamin B12 deficiency, which warrant-specific treatment. Finally, physical inactivity in patients with sarcoidosis correlated with lower quality-of-life (QOL) scores and possibly fatigue. Multidisciplinary programs that include physical therapy, patient education and psychological support were found to improve fatigue and mood disorders. SUMMARY Recognition of nonorgan-related symptoms and their impact on patient QOL is essential to optimal treatment of the sarcoidosis patient.
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Affiliation(s)
- Jinny Tavee
- Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL
- Department of Pulmonary Medicine, Cleveland Clinic Foundation, Cleveland OH
| | - Daniel Culver
- Sarcoidosis Center, Cleveland Clinic Foundation, Cleveland, Ohio, USA
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Scalp hair cortisol and testosterone levels in patients with sarcoidosis. PLoS One 2019; 14:e0215763. [PMID: 31199799 PMCID: PMC6568399 DOI: 10.1371/journal.pone.0215763] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2019] [Accepted: 04/05/2019] [Indexed: 01/07/2023] Open
Abstract
Background Patients with sarcoidosis often experience fatigue and psychological distress, but little is known about the etiology of these conditions. While serum and saliva steroid hormones are used to monitor acute steroid levels, scalp hair analysis is a relatively new method enabling measurement of long-term steroid levels, including hair cortisol reflecting chronic stress. We investigated whether scalp hair cortisol and testosterone levels differ between sarcoidosis patients both with and without fatigue and general population controls. Additionally, we studied if these hormones could serve as objective biomarkers for psychological distress in patients with sarcoidosis. Methods We measured hair steroid levels using liquid chromatography–tandem mass spectrometry in glucocorticoid naïve sarcoidosis patients. Patients completed the Perceived Stress Scale, Fatigue Assessment Scale, Hospital Anxiety and Depression Scale and Short Form 36 (SF-36). Hair steroid levels from 293 participants of the population-based Lifelines cohort study served as controls. Results Thirty-two patients (14 males) were included. Hair cortisol, but not testosterone, concentrations were significantly higher in patients with sarcoidosis than in general population controls (mean 6.6 versus 2.7 pg/mg, p<0.001). No differences were found in hair cortisol and testosterone levels between fatigued and non-fatigued patients with sarcoidosis. Hair cortisol of sarcoidosis patients correlated significantly with anxiety (r = 0.47, p = 0.01), depression (r = 0.46, p = 0.01), and SF-36 mental domain (r = -0.38, p = 0.03), but not with fatigue. Conclusions Patients with sarcoidosis have chronically higher levels of the stress hormone cortisol than the normal population, while testosterone levels in hair did not differ. Hair cortisol levels were positively related to subjective measures of psychological distress, but not to fatigue. Our study shows that hair cortisol is a promising non-invasive biomarker for psychological distress in patients with sarcoidosis. Trial registration ClinicalTrials.gov: NCT03108547. Registered 31 March 2017, retrospectively registered.
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Grongstad A, Vøllestad NK, Oldervoll LM, Spruit MA, Edvardsen A. The effects of High- versus Moderate-Intensity Exercise on Fatigue in Sarcoidosis. J Clin Med 2019; 8:jcm8040460. [PMID: 30959786 PMCID: PMC6518363 DOI: 10.3390/jcm8040460] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Revised: 03/25/2019] [Accepted: 04/02/2019] [Indexed: 12/17/2022] Open
Abstract
Background: Fatigue is a common symptom in patients with sarcoidosis. Despite lacking evidence on whether high-intensity interval training (HIIT) will aggravate fatigue, moderate-intensity exercise is often recommended. This study aimed to investigate whether a single session of HIIT would affect fatigue differently from a single session of moderate-intensity continuous training (MICT). Methods: Forty-one patients with pulmonary sarcoidosis were recruited to a cross-over study. All patients completed one treadmill session of HIIT (85% of peak heart rate (HRpeak)) and one of MICT (70% of HRpeak). Fatigue was assessed with the Visual Analogue Scale 0–100 mm, before (T0), after (T1), and 24 hours after (T2) each exercise session. Paired sample t-test was used to compare changes in fatigue from T0 to T1 and from T0 to T2 between HIIT and MICT. Results: No statistically significant difference in fatigue levels was found between HIIT and MICT, either at T1 (3.6 (13.5) and 1.4 (13.5)) or at T2 (8.2 (17.0) and 2.1 (17.1)). Conclusions: A single session of HIIT did not affect fatigue differently than a single session of MICT. These preliminary findings support the need for further research on the long-term effect of HIIT on fatigue in patients with sarcoidosis.
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Affiliation(s)
- Anita Grongstad
- LHL Hospital Gardermoen, 2067 NO Jessheim, Norway.
- Department of Interdisciplinary Health Sciences, University of Oslo, 0318 NO Oslo, Norway.
| | - Nina K Vøllestad
- Department of Interdisciplinary Health Sciences, University of Oslo, 0318 NO Oslo, Norway.
| | - Line M Oldervoll
- LHL, Clinics Trondheim, 7041 NO Trondheim, Norway.
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Technology and Science (NTNU), 7491 NO Trondheim, Norway.
| | - Martijn A Spruit
- Department of Research & Education, CIRO, Center of Expertise for Chronic Organ Failure, 6085 NM Horn, The Netherlands.
- Department of Respiratory Medicine, Maastricht University Medical Centre, NUTRIM School of Nutrition and Translational Research in Metabolism, 6229 HX Maastricht, The Netherlands.
- REVAL-Rehabilitation Research Center, BIOMED-Biomedical Research Institute, Faculty of Rehabilitation Sciences, Hasselt University, 3590 BE Diepenbeek, Belgium.
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Acceptability of a Dyadic Tai Chi Intervention for Older People Living With Dementia and Their Informal Carers. J Aging Phys Act 2019; 27:166-183. [PMID: 30160584 DOI: 10.1123/japa.2017-0267] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Exercise is effective in preventing falls among older adults. However, few studies have included people living with dementia and their carers and explored their experiences. The aim of this study is to explore what affects the acceptability of exercise interventions to better meet the needs of people with dementia and their carers as a dyad. Observations, field notes containing participant's and instructor's feedback, and focus groups with 10 dyads involved in Tai Chi classes for 3 or 4 weeks in two sites in the South of England were thematically analyzed to understand their experiences. Findings suggest that dyads' determination to achieve the benefits of Tai Chi facilitated their adherence, whereas a member of the dyad's low sense of efficacy performing the movements during classes was a barrier. Simplifying class content and enhancing the clarity of instructions for home-based practice will be key to support the design of future exercise interventions.
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Moor CC, van Manen MJG, van Hagen PM, Miedema JR, van den Toorn LM, Gür-Demirel Y, Berendse APC, van Laar JAM, Wijsenbeek MS. Needs, Perceptions and Education in Sarcoidosis: A Live Interactive Survey of Patients and Partners. Lung 2018; 196:569-575. [PMID: 30088094 PMCID: PMC6153596 DOI: 10.1007/s00408-018-0144-4] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Accepted: 08/03/2018] [Indexed: 12/17/2022]
Abstract
Objectives Sarcoidosis is a chronic, multisystem disease with often a major impact on quality of life. Information on unmet needs of patients and their partners is lacking. We assessed needs and perceptions of sarcoidosis patients and their partners. Methods During patient information meetings in 2015 and 2017 in the Erasmus University Medical Center, we interviewed patients and partners using interactive voting boxes. Patients responded anonymously to 17 questions. Answers were projected directly on the screen in the room. Results 210 patients and 132 partners participated. Sarcoidosis has a subjective significant impact on lives of both patients and partners. The vast majority of patients and partners feel regularly misunderstood because of the general unawareness of sarcoidosis. Many patients and partners experience anxiety. Three-quarters of patients would like to see more attention and support for their psychological problems. Additionally, more supportive care for partners of sarcoidosis patients is warranted. Interactive interviewing was considered educational (91%) and pleasant (84%). Discussion This study improves awareness of needs and perceptions of patients with sarcoidosis and their partners. Sarcoidosis leads to anxiety and psychological distress and impairs well-being of patients and their partners. Attention for psychological support, better disease education, and more supportive care for partners is warranted.
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Affiliation(s)
- C C Moor
- Department of Respiratory Medicine, Erasmus University Medical Center, s-Gravendijkwal 230, Rotterdam, 3015 CE, The Netherlands
| | - M J G van Manen
- Department of Respiratory Medicine, Erasmus University Medical Center, s-Gravendijkwal 230, Rotterdam, 3015 CE, The Netherlands
| | - P M van Hagen
- Departments of Immunology and Internal Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - J R Miedema
- Department of Respiratory Medicine, Erasmus University Medical Center, s-Gravendijkwal 230, Rotterdam, 3015 CE, The Netherlands
| | - L M van den Toorn
- Department of Respiratory Medicine, Erasmus University Medical Center, s-Gravendijkwal 230, Rotterdam, 3015 CE, The Netherlands
| | - Y Gür-Demirel
- Department of Respiratory Medicine, Erasmus University Medical Center, s-Gravendijkwal 230, Rotterdam, 3015 CE, The Netherlands
| | - A P C Berendse
- Dutch Sarcoidosis Patient Organisation (Sarcoidose.nl), Alkmaar, The Netherlands
| | - J A M van Laar
- Departments of Immunology and Internal Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - M S Wijsenbeek
- Department of Respiratory Medicine, Erasmus University Medical Center, s-Gravendijkwal 230, Rotterdam, 3015 CE, The Netherlands.
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Atkins CP, Jones AP, Wilson AM. Measuring activity in patients with sarcoidosis - a pilot trial of two wrist-worn accelerometer devices. SARCOIDOSIS, VASCULITIS, AND DIFFUSE LUNG DISEASES : OFFICIAL JOURNAL OF WASOG 2018; 35:62-68. [PMID: 32476881 PMCID: PMC7170060 DOI: 10.36141/svdld.v35i1.5848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Accepted: 02/06/2018] [Indexed: 11/02/2022]
Abstract
Introduction: Increasing physical activity is associated with health benefits. Reduced physical activity has been noted in sarcoidosis, particularly where fatigue co-exists. Monitoring physical activity is possible with wrist-worn devices. This study compared two available devices to determine patient preference and compare wear-time, with a secondary outcome of comparing device outputs with fatigue scores. Methods: Patients with sarcoidosis wore two wrist-worn activity monitors (GENEActiv actiwatch and Actigraph GT3X-bt) separately for seven days each. Participants were randomly allocated to receive either device first. Participants completed the Fatigue Assessment Scale (FAS) questionnaire immediately before wearing the first device. All participants completed a questionnaire of their perception regarding each device after the wear period. Data from the devices was analysed for total wear time, time spent in moderate or vigorous activity (MVPA) and for time spent in sedentary behaviours. Results: Twelve patients with sarcoidosis were included. The GENEActiv device was preferred by ten (83.3%) participants. Wear time was greater with the GENEActiv device (1354 minutes/day vs 1079 minutes/day). Time spent in MVPA was slightly higher when recorded by the GENEActiv compared with the Actigraph. Moderately strong correlation was seen between FAS scores and sedentary time (r=-0.554), light activity (r=-0.585) and moderate activity (r=0.506). Discussion: A clear preference was demonstrated for the GENEActiv. This was reflected in higher wear time and suggests the device can be comfortably worn 24 hours per day. Data from this small cohort also suggests there is correlation between fatigue and activity scores in patients with sarcoidosis. (Sarcoidosis Vasc Diffuse Lung Dis 2018; 35: 62-68).
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Affiliation(s)
- Christopher P. Atkins
- Norwich Medical School, University of East Anglia, Norwich, Norfolk, UK, NR4 7TJ
- Norfolk and Norwich University Hospital, Colney Lane, Norwich, UK, NR4 7UQ
| | - Andy P. Jones
- Norwich Medical School, University of East Anglia, Norwich, Norfolk, UK, NR4 7TJ
| | - Andrew M. Wilson
- Norwich Medical School, University of East Anglia, Norwich, Norfolk, UK, NR4 7TJ
- Norfolk and Norwich University Hospital, Colney Lane, Norwich, UK, NR4 7UQ
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Lingner H, Buhr-Schinner H, Hummel S, van der Meyden J, Grosshennig A, Nowik D, Schultz K. Short-Term Effects of a Multimodal 3-Week Inpatient Pulmonary Rehabilitation Programme for Patients with Sarcoidosis: The ProKaSaRe Study. Respiration 2018; 95:343-353. [DOI: 10.1159/000486964] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Accepted: 01/16/2018] [Indexed: 11/19/2022] Open
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Abstract
PURPOSE OF REVIEW Up to twenty percent of patients with sarcoidosis develop pulmonary fibrosis, transforming an often benign disease into a highly morbid and potentially fatal one. We highlight the fibrotic pulmonary sarcoidosis phenotype as an area of intense clinical and translational investigation, review recent developments in treatment, and provide a roadmap for future research in sarcoidosis associated pulmonary fibrosis. RECENT FINDINGS Granulomatous inflammation in a lymphatic distribution is the hallmark finding of pulmonary sarcoidosis and the nidus for fibrosis. Recent research demonstrates that fibrotic sarcoidosis begins in the setting of persistent, uncontrolled inflammation, and is aided by pro-fibrotic genetic features and immune responses. Comparison to other fibrotic lung diseases also reveals key features that inform our understanding of common pathways in fibrosis. SUMMARY Understanding the mechanisms of fibrotic transformation in sarcoidosis enhances clinical care and facilitates development of novel therapeutic options. The impact of these findings in fibrotic sarcoidosis may be amplified through application to other interstitial lung diseases marked by inflammatory to fibrotic transformation. Important aspects of clinical management of fibrotic sarcoidosis include surveillance for co-morbidities, such as pulmonary hypertension, airway disease, and infection, and assessment for pulmonary disease activity that may benefit from immunosuppression.
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Thunold RF, Løkke A, Cohen AL, Ole H, Bendstrup E. Patient reported outcome measures (PROMs) in sarcoidosis. SARCOIDOSIS VASCULITIS AND DIFFUSE LUNG DISEASES 2017; 34:2-17. [PMID: 32476819 DOI: 10.36141/svdld.v34i1.5760] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 09/22/2016] [Accepted: 09/27/2016] [Indexed: 02/01/2023]
Abstract
Patients with sarcoidosis present with a variety of symptoms which may impair many aspects of physical and mental well-being. Traditionally, clinicians have been concerned with physical health aspects of sarcoidosis, assessing disease activity and severity with radiological imaging, pulmonary function and blood tests. However, the most reported symptom of sarcoidosis patients, fatigue, has been shown not to correlate with the most commonly used parameters for monitoring disease activity. Studies have shown poor agreement between physicians and patients in assessing sarcoidosis symptoms. This underlines the importance of patient reported outcomes (PROs) in addition to traditional outcomes in order to provide a complete evaluation of the effects of interventions in clinical trials and everyday clinical assessment of sarcoidosis. We have undertaken a systematic review to identify and provide an overview of PRO concepts used in sarcoidosis assessment the past 20 years and to evaluate the tools used for measuring these concepts, called patient reported outcome measures (PROMs). Various PROMs have been used. By categorizing these PROMs according to outcome we identified the key PRO concepts for sarcoidosis to be Health Status and Quality of Life, Dyspnea, Fatigue, Depression, Anxiety and Stress and Miscellaneous. There is no perfect sarcoidosis-specific PROM to cover all concepts and future intervention studies should therefore contain multiple complementary questionnaires. Based on our findings we recommend the Fatigue Assessment Scale (FAS) for assessing fatigue. Dyspnea scores should be chosen based on their purpose; more research is needed to examine their validity in sarcoidosis. The Modified Medical Research Council Dyspnea Scale (MRC) can be used to screen for dyspnea and the Baseline Dyspnea Index (BDI) to detect changes in dyspnea. We recommend The World Health Organization Quality of Life assessment instrument (WHOQOL-100) for assessing quality of life, although a shorter questionnaire would be preferable. For assessing health status we recommend the Sarcoidosis Assessment Tool (SAT), and have great expectations for this new and promising assessment tool. Supplementary to the WASOG meeting of 2011's recommendation on assessing QoL, we recommend incorporating fatigue, dyspnea and HS assessment in clinical trials and everyday clinical assessment of sarcoidosis. (Sarcoidosis Vasc Diffuse Lung Dis 2017; 34: 2-17).
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Affiliation(s)
- Rikke Flor Thunold
- Department of Internal Medicine Orkdale, St. Olavs University Hospital, Trondheim, Norway
| | - Anders Løkke
- Department of Respiratory Diseases and Allergology, Aarhus University Hospital, Aarhus, Denmark
| | - Adam Langballe Cohen
- Department of Internal Medicine Orkdale, St. Olavs University Hospital, Trondheim, Norway
| | - Hilberg Ole
- Department of Medicine, Lillebaelt Hospital, Vejle, Denmark
| | - Elisabeth Bendstrup
- Department of Respiratory Diseases and Allergology, Aarhus University Hospital, Aarhus, Denmark
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Nakazawa A, Cox NS, Holland AE. Current best practice in rehabilitation in interstitial lung disease. Ther Adv Respir Dis 2017; 11:115-128. [PMID: 28150539 PMCID: PMC5933636 DOI: 10.1177/1753465816676048] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Interstitial lung disease (ILD) is a group of chronic respiratory diseases characterized by dyspnoea on exertion and decline in health-related quality of life (HRQL). People with ILD experience significant exercise limitation with contributors that include ventilatory limitation, impaired gas exchange, decreased cardiac function and skeletal muscle dysfunction. Pulmonary rehabilitation (PR) is well established in patients with chronic obstructive pulmonary disease (COPD) as a means to overcome exercise limitation and improve activity-related dyspnoea. There is increasing evidence for similar effects of PR in people with ILD. This review discusses the evidence for PR in ILD, outlines the essential components of PR in this population, and highlights special considerations for exercise training in people with ILD. Possible future directions for PR research in people with ILD are explored.
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Affiliation(s)
- Atsuhito Nakazawa
- Physiotherapy, School of Allied Health, La Trobe
University, Melbourne, Victoria, Australia
| | - Narelle S. Cox
- Physiotherapy, School of Allied Health, La Trobe
University, Melbourne, Victoria, Australia Institute for Breathing and
Sleep, Melbourne, Victoria, Australia
| | - Anne E. Holland
- La Trobe University & Alfred Health, Level
4, The Alfred Centre, 99 Commercial Road, Melbourne, Victoria 3004,
Australia and Physiotherapy, School of Allied Health, La Trobe University,
Melbourne, Victoria, Australia
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Strookappe B, Saketkoo LA, Elfferich M, Holland A, De Vries J, Knevel T, Drent M. Physical activity and training in sarcoidosis: review and experience-based recommendations. Expert Rev Respir Med 2016; 10:1057-68. [PMID: 27552344 DOI: 10.1080/17476348.2016.1227244] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Sarcoidosis is a multisystemic inflammatory disorder with a great variety of symptoms, including fatigue, dyspnea, pain, reduced exercise tolerance and muscle strength. Physical training has the potential to improve exercise capacity and muscle strength, and reduce fatigue. The aim of this review and survey was to present information about the role of physical training in sarcoidosis and offer practical guidelines. AREAS COVERED A systematic literature review guided an international consensus effort among sarcoidosis experts to establish practice-basic recommendations for the implementation of exercise as treatment for patients with various manifestations of sarcoidosis. International sarcoidosis experts suggested considering physical training in symptomatic patients with sarcoidosis. Expert commentary: There is promising evidence of a positive effect of physical training. Recommendations were based on available data and expert consensus. However, the heterogeneity of these patients will require modification and program adjustment of the standard rehabilitation format for e.g. COPD or interstitial lung diseases. An optimal training program (types of exercise, intensities, frequency, duration) still needs to be defined to optimize training adjustments, especially reduction of fatigue. Further randomized controlled trials are needed to consolidate these findings and optimize the comprehensive care of sarcoidosis patients.
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Affiliation(s)
- Bert Strookappe
- a Department of Physical Therapy Hospital Gelderse Vallei , ZGV , Ede , Netherlands.,b ILD care foundation research team , Ede , Netherlands.,c ILD Center of Excellence , St. Antonius Hospital Nieuwegein , Nieuwegein , Netherlands
| | - Lesley Ann Saketkoo
- b ILD care foundation research team , Ede , Netherlands.,d New Orleans Scleroderma and Sarcoidosis Patient Care and Research Center , Tulane University Lung Center , New Orleans , LA , USA
| | - Marjon Elfferich
- a Department of Physical Therapy Hospital Gelderse Vallei , ZGV , Ede , Netherlands.,b ILD care foundation research team , Ede , Netherlands
| | - Anne Holland
- e Department of Rehabilitation , Nutrition and Sport, Alfred Health and La Trobe University Clinical School , Melbourne , Australia
| | - Jolanda De Vries
- b ILD care foundation research team , Ede , Netherlands.,f Department of Medical Psychology, Elisabeth TweeSteden Ziekenhuis Tilburg and Department of Medical and Clinical Psychology, CoRPS , Tilburg University , Tilburg , Netherlands
| | - Ton Knevel
- a Department of Physical Therapy Hospital Gelderse Vallei , ZGV , Ede , Netherlands
| | - Marjolein Drent
- b ILD care foundation research team , Ede , Netherlands.,c ILD Center of Excellence , St. Antonius Hospital Nieuwegein , Nieuwegein , Netherlands.,g Department of Pharmacology and Toxicology, Faculty of Health, Medicine and Life Science , Maastricht University , Maastricht , Netherlands
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Atkins C, Wilson AM. Managing fatigue in sarcoidosis - A systematic review of the evidence. Chron Respir Dis 2016; 14:161-173. [PMID: 27507833 DOI: 10.1177/1479972316661926] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Fatigue is a common manifestation of sarcoidosis, often persisting without evidence of disease activity. First-line therapies for sarcoidosis have limited effect on fatigue. This review aimed to assess the treatment options targeting sarcoidosis-associated fatigue. Medline and Web of Science were searched in November 2015; the bibliographies of these papers, and relevant review papers, were also searched. Studies were included if they reported on the efficacy of interventions (both pharmacological and non-pharmacological) on fatigue scores in sarcoidosis patients. Eight studies were identified that fulfilled the inclusion criteria. These studies evaluated six different interventions (infliximab, adalimumab, ARA 290, methylphenidate, armodafinil and exercise programmes). There is evidence to support a treatment effect of anti-tumour necrosis factor (TNF)-αtherapies (adalimumab and infliximab) and neurostimulants (methylphenidate and armodafinil), but within five of the studies, the risk of bias was high within most domains and the remaining three studies included only small numbers of participants and were short in duration. Trial evidence for treating fatigue as a manifestation of sarcoidosis is limited and requires further investigation. Anti-TNF-α therapies may be beneficial in patients with organ-threatening disease. Neurostimulants have some trial evidence supporting improvements in fatigue but further investigation is needed before they can be recommended.
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Affiliation(s)
- Chris Atkins
- Norwich Medical School, University of East Anglia, Norwich, Norfolk, UK
| | - Andrew M Wilson
- Norwich Medical School, University of East Anglia, Norwich, Norfolk, UK
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Strookappe B, De Vries J, Elfferich M, Kuijpers P, Knevel T, Drent M. Predictors of fatigue in sarcoidosis: The value of exercise testing. Respir Med 2016; 116:49-54. [DOI: 10.1016/j.rmed.2016.05.010] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2015] [Revised: 04/16/2016] [Accepted: 05/11/2016] [Indexed: 11/29/2022]
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Zhou Y, Lower EE, Li H, Baughman RP. Clinical management of pulmonary sarcoidosis. Expert Rev Respir Med 2016; 10:577-91. [DOI: 10.1586/17476348.2016.1164602] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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