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Ruza I, Lucane Z, Vanaga E, Persana M, Vitenberga-Verza Z, Strumfa I. Osteoporotic bone fracture risk assessment in Latvian patients with newly diagnosed sarcoidosis. SARCOIDOSIS, VASCULITIS, AND DIFFUSE LUNG DISEASES : OFFICIAL JOURNAL OF WASOG 2024; 41:e2024020. [PMID: 38940714 PMCID: PMC11275542 DOI: 10.36141/svdld.v41i2.15156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 09/02/2023] [Accepted: 01/17/2024] [Indexed: 06/29/2024]
Abstract
BACKGROUND AND AIM Increased calcitriol synthesis in sarcoid granulomas with subsequent hypercalcaemia and hypercalciuria can affect bone metabolism in patients with sarcoidosis. Multiple factors can increase the fracture risk in patients with sarcoidosis. This study aimed to evaluate a 10-year osteoporotic and a 10-year hip fracture risk and to analyse factors affecting fracture risk for patients with newly diagnosed sarcoidosis compared to an age- and gender-matched control group from a real-world setting. METHODS The cross-sectional study included 171 patients with a histologically verified diagnosis of sarcoidosis who were hospitalised due to suspected sarcoidosis within two years and an age- and gender-matched control group of 178 hospitalised individuals. QFracture algorithm questions were asked during interviews. RESULTS A cohort of 349 subjects was analysed. The median age in the patient group was 40 years (IQR:20), and 60.2% were female. 21.6% of patients with sarcoidosis had at least one comorbidity that could potentially influence the osteoporotic fracture risk. Both the median 10-year osteoporotic fracture risk (0.9% (IQR:2) vs 1.3% (IQR:2.3), p=0.005; U=12394) and a 10-year hip fracture risk (0.1% (IQR:0.3) vs 0.2% (IQR:0.5), p=0.003; U=12368.5) was lower in patients with sarcoidosis compared to control group subjects. As compared to the control group, individuals with sarcoidosis exhibited a lower frequency of both osteoporotic (2.4% vs 11.2%, OR=0.189 (95% CI:0.063-0.566), p=0.003) and low-energy trauma fractures (2.9% vs 11.8%, OR=0.225 (95% CI:0.083-0.612), p=0.003) in personal medical history. CONCLUSIONS This was the first study to investigate osteoporotic fracture risk and related factors in Latvian patients with newly diagnosed sarcoidosis. Our data show a lower risk of a 10-year osteoporotic and a 10-year hip fracture risk in patients with sarcoidosis compared to age- and gender-matched control group subjects from a real-world setting.
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Affiliation(s)
- Ieva Ruza
- Department of Endocrinology, Riga East Clinical University Hospital, Riga, Latvia
- Department of Internal Medicine, Riga Stradins University, Riga, Latvia
| | - Zane Lucane
- Department of Internal Medicine, Riga Stradins University, Riga, Latvia
| | - Elina Vanaga
- Department of Internal Medicine, Riga Stradins University, Riga, Latvia
| | - Marta Persana
- Department of Internal Medicine, Riga Stradins University, Riga, Latvia
| | | | - Ilze Strumfa
- Department of Pathology, Riga Stradins University, Riga, Latvia
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Bonella F, Dm Vorselaars A, Wilde B. Kidney manifestations of sarcoidosis. J Autoimmun 2024:103207. [PMID: 38521611 DOI: 10.1016/j.jaut.2024.103207] [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: 01/30/2024] [Revised: 03/11/2024] [Accepted: 03/18/2024] [Indexed: 03/25/2024]
Abstract
Renal involvement is a clinically relevant organ manifestation of sarcoidosis, leading to increased morbidity and complications. Although the exact incidence remains unknown, renal disease is likely to occur in up to one third of all sarcoidosis patients. Every patient with newly diagnosed sarcoidosis should receive a renal work-up and screening for disrupted calcium metabolism. Amid various forms of glomerulonephritis, granulomatous interstitial nephritis is the most common one, but it rarely leads to renal impairment. Histologically, granulomas can be absent. Nephrocalcinosis and nephrolithiasis are frequent forms when hypercalcaemia or hypercalciuria occur. Drugs used for treatment of systemic sarcoidosis can also cause renal damage. Due to its high heterogeneity, renal sarcoidosis can be difficult to treat. Glucocorticoids and various immunosuppressive treatments have been proven to be effective based on case series, but clinical trials are lacking. A treatment guideline for renal sarcoidosis is urgently needed. In this review article, we present an overview of the different forms of renal sarcoidosis and the diagnostic steps to confirm renal involvement; in addition, we provide insights on the management and available treatments. A better understanding regarding the pathogenesis of sarcoidosis is the key for the development of more specific, targeted therapies.
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Affiliation(s)
- Francesco Bonella
- Center for interstitial and rare lung diseases, Ruhrlandklinik University Hospital, University of Duisburg-Essen, Essen, Germany.
| | - Adriane Dm Vorselaars
- Division of Heart and Lungs, University Medical Center Utrecht, Utrecht, the Netherlands; Interstitial Lung Diseases Center of Excellence, Department of Pulmonology, St Antonius Hospital, Nieuwegein, the Netherlands
| | - Benjamin Wilde
- Department of Nephrology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
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Błasińska K, Jędrych ME, Opoka L, Tomkowski W, Szturmowicz M. Imaging Plays a Key Role in the Diagnosis and Control of the Treatment of Bone Sarcoidosis. Biomedicines 2023; 11:1866. [PMID: 37509505 PMCID: PMC10377349 DOI: 10.3390/biomedicines11071866] [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: 05/26/2023] [Revised: 06/23/2023] [Accepted: 06/27/2023] [Indexed: 07/30/2023] Open
Abstract
Sarcoidosis is a multisystem granulomatous disease of unknown origin. The most frequent localizations are thoracic lymph nodes and/or parenchymal lung disease, nevertheless any other organ may be involved. Musculoskeletal sarcoidosis, previously considered a rare manifestation of the disease, is presently recognized with increasing frequency, due to the development of modern imaging modalities. The classical X-ray sign of bone sarcoidosis is the image of lace in the phalanges of the hands. Most other locations present with atypical radiological images. Therefore, they may mimic metastatic neoplastic disease, especially when they are the first sign of sarcoidosis not previously recognized. On such occasions, none of the imaging methods will give the correct diagnosis, histopathological verification, monitoring of lesions or clinical data in a patient with confirmed sarcoidosis are indicated. The article summarizes the current status of knowledge concerning the recognition and therapy of bone sarcoidosis. In addition, an illustrative case of patient with bone and bone marrow sarcoidosis is presented.
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Affiliation(s)
- Katarzyna Błasińska
- Department of Radiology, National Tuberculosis and Lung Diseases Research Institute, 01-138 Warsaw, Poland
| | - Małgorzata Ewa Jędrych
- 1st Department of Lung Diseases, National Tuberculosis and Lung Diseases Research Institute, 01-138 Warsaw, Poland
| | - Lucyna Opoka
- Department of Radiology, National Tuberculosis and Lung Diseases Research Institute, 01-138 Warsaw, Poland
| | - Witold Tomkowski
- 1st Department of Lung Diseases, National Tuberculosis and Lung Diseases Research Institute, 01-138 Warsaw, Poland
| | - Monika Szturmowicz
- 1st Department of Lung Diseases, National Tuberculosis and Lung Diseases Research Institute, 01-138 Warsaw, Poland
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Brennan M, Breen D. Sarcoidosis in the older person: diagnostic challenges and treatment consideration. Age Ageing 2022; 51:6695454. [PMID: 36088599 DOI: 10.1093/ageing/afac203] [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: 12/03/2021] [Revised: 03/20/2022] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Sarcoidosis is a multi-system disorder with an increasing propensity to present in older patients. Diagnostic uncertainty is common and understandable given the higher prevalence of co-morbidities in older patients and broad differential for multi-system clinical presentations. Excluding malignancy and infection with a high degree of certainty is challenging and may require repeated confirmatory investigation where the diagnosis remains in doubt. SUMMARY OF MAIN FINDINGS There are a paucity of studies examining late-onset sarcoidosis. Female predominance, pulmonary, ocular, skin and systemic symptoms are common, while more classical presentations such as Lofgren's syndrome are uncommon. Positivity rates of biopsies vary between studies; however, targeted biopsies of accessible sites with organ involvement are the most successful. Therapeutic management is directed at reducing inflammation, and thereby reducing symptom burden, improving quality of life and avoiding progression of organ damage. While most older patients will require corticosteroid therapy, they are also more prone to developing adverse effects. Most older patients will experience a clinical remission; however, the risk of developing chronic sarcoidosis and organ damage is higher compared with younger counterparts. Patients with evidence of pulmonary fibrosis and pulmonary hypertension are at particular risk. IMPACT ON CLINICAL PRACTICE Health care providers who care for older adults should be aware of the increasing prevalence of late-onset sarcoidosis and consider the diagnosis in those who present with otherwise unexplained systemic symptoms, thoracic abnormalities on imaging and/or evidence of other organ involvement. Earlier diagnosis and therapeutic intervention to halt the development of pulmonary fibrosis and pulmonary hypertension and monitoring for treatment-related adverse effects will confer a mortality benefit.
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Affiliation(s)
- Michelle Brennan
- Department of Geriatric Medicine, Galway University Hospital, Galway, Ireland.,Interventional Respiratory Unit, Department of Respiratory Medicine, Galway University Hospital, Galway, Ireland
| | - David Breen
- Interventional Respiratory Unit, Department of Respiratory Medicine, Galway University Hospital, Galway, Ireland
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Simmering J, Stapleton EM, Polgreen PM, Kuntz J, Gerke AK. Patterns of medication use and imaging following initial diagnosis of sarcoidosis. Respir Med 2021; 189:106622. [PMID: 34600163 PMCID: PMC10918686 DOI: 10.1016/j.rmed.2021.106622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 08/31/2021] [Accepted: 09/14/2021] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Sarcoidosis is a rare inflammatory disease with unclear natural history. Using a large, retrospective, longitudinal, population-based cohort, we sought to define its natural history in order to guide future clinical studies. METHODS We identified 722 newly diagnosed cases of sarcoidosis within Kaiser Permanente Northwest health care records between 1995 and 2015. We investigated immunosuppressive medication use in the two years following diagnosis, analyzed demographic and clinical characteristics, and quantified chest imaging and pulmonary function testing (PFTs) across the clinical course. RESULTS Over two years of follow-up, 41% of patients were treated with prednisone. Of those, 75% tapered off their first course within 100 days, although half of those patients required recurrent therapy. Five percent of the entire cohort remained on prednisone for longer than one year, with an average daily dose of 10-20 mg. Chest imaging was associated with early prednisone use, and chest CT was associated with changes in prednisone dose. PFTs or demographics were not associated with prednisone use. Cumulative prednisone doses were significantly higher in African Americans (1,845 mg additional) and those who had a chest CT (2,015 mg additional). Overall, PFTs were less frequently obtained than chest imaging and had no significant change over disease course. DISCUSSION The natural history of sarcoidosis varies greatly. For those requiring therapy, corticosteroid burden is high. Chest imaging drives medication dose changes as compared to PFTs, but neither outcome fully captures the entire history of disease. Prospective cohorts are needed with purposefully collected, repeated measures that include objective clinical assessments and symptoms.
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Affiliation(s)
- J Simmering
- University of Iowa, Department of Internal Medicine, Division of Pulmonary and Critical Care Medicine, 200 Hawkins Dr., C33GH, Iowa City, IA, 52242, USA
| | - E M Stapleton
- University of Iowa, Department of Internal Medicine, Division of Pulmonary and Critical Care Medicine, 200 Hawkins Dr., C33GH, Iowa City, IA, 52242, USA
| | - P M Polgreen
- University of Iowa, Department of Internal Medicine, Division of Pulmonary and Critical Care Medicine, 200 Hawkins Dr., C33GH, Iowa City, IA, 52242, USA
| | - J Kuntz
- Kaiser Permanente Northwest Center for Health Research, 3800 N. Interstate Ave., Portland, OR, 97227, USA
| | - A K Gerke
- University of Iowa, Department of Internal Medicine, Division of Pulmonary and Critical Care Medicine, 200 Hawkins Dr., C33GH, Iowa City, IA, 52242, USA.
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Nel H, Davis B, Adler B, Gabbay E. Case report of osteolytic lesions in a patient with multisystem granulomatous disease. BMJ Case Rep 2021; 14:14/6/e242685. [PMID: 34108156 DOI: 10.1136/bcr-2021-242685] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
We present a case of a 70-year-old Caucasian woman with multisystem granulomatous disease involving her lungs, bones and lymph nodes. The patient initially presented with cervical lymphadenopathy and subsequently developed progressive breathlessness. Imaging revealed extensive mediastinal, hilar and intra-abdominal lymphadenopathy as well as bilateral pulmonary parenchymal infiltrates. Lymph node and lung biopsy confirmed non-necrotising granulomatous inflammation while a BAL showed scanty growth of Cryptococcus neoformans and moderate growth of Staphylococcus aureus The patient received intravenous ceftriaxone and had a good response to treatment. She also completed 3 months of oral fluconazole. Although a diagnosis of sarcoidosis was considered most likely, the patient was not initially started on systemic corticosteroids due to concern around possible infection and initial response to antimicrobials. However, her exercise tolerance gradually deteriorated. A craniofacial CT revealed multiple lytic lesions involving the skull and visualised cervical spine. Biopsy of a clivus lesion revealed non-necrotising granulomatous inflammation while fungal cultures and histopathological stains were negative. The patient was diagnosed with widespread sarcoidosis and she was initiated on prednisolone and methotrexate which led to marked clinical and radiological improvement.
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Affiliation(s)
- Henco Nel
- Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
| | - Brad Davis
- SKG Radiology, St John of God Subiaco, Perth, Western Australia, Australia
| | - Brendan Adler
- Envision Medical Imaging, Perth, Western Australia, Australia
| | - Eli Gabbay
- School of Medicine, University of Notre Dame, Fremantle, Western Australia, Australia
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Charifi Y, Dkhissi Y, Haloua M, Alaoui Lamrani Y, Berrady G, Boubbou M, Amarti A, Maaroufi M, Alami B. Pelvic and Lumbar Pain Revealing Bone Sarcoidosis: A Case Report. CLINICAL MEDICINE INSIGHTS-CASE REPORTS 2021; 14:11795476211014788. [PMID: 34017208 PMCID: PMC8114277 DOI: 10.1177/11795476211014788] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Accepted: 04/13/2021] [Indexed: 11/22/2022]
Abstract
A 54-years-old woman suffered from a bilateral pelvic and lumbar pain. She had a systemic investigation shows a diffuse bone lesions. A biopsy of iliac bone was done and revealed sarcoidosis. Bony manifestations of sarcoidosis are rare and challenging to diagnose. Our report shows that MRI with diffusion weighted sequences is a simple and non invasive technique to evaluate bone infiltration. It helps to distinguish inflammatory disease from metastatic lesions and to guide the osseous biopsy. Moreover, fluorodeoxyglucose PET scan, are useful in establishing the extent of damage and measuring disease activity.
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Affiliation(s)
- Yahya Charifi
- Radiology and Imaging Department, Centre Hospitalier Universitaire Hassan II, University Sidi Mohamed Ben Abdellah, Fez, Morocco
| | - Younes Dkhissi
- Radiology and Imaging Department, Centre Hospitalier Universitaire Hassan II, University Sidi Mohamed Ben Abdellah, Fez, Morocco
| | - Meryem Haloua
- Radiology and Imaging Department, Centre Hospitalier Universitaire Hassan II, University Sidi Mohamed Ben Abdellah, Fez, Morocco
| | - Youssef Alaoui Lamrani
- Radiology and Imaging Department, Centre Hospitalier Universitaire Hassan II, University Sidi Mohamed Ben Abdellah, Fez, Morocco
| | - Ghizlane Berrady
- Internal Medicine Department, Centre Hospitalier Universitaire Hassan II, University Sidi Mohamed Ben Abdellah, Fez, Morocco
| | - Meryem Boubbou
- Radiology and Imaging Department, Centre Hospitalier Universitaire Hassan II, University Sidi Mohamed Ben Abdellah, Fez, Morocco
| | - Afaf Amarti
- Anatomopathology Department, Centre Hospitalier Universitaire Hassan II, University Sidi Mohamed Ben Abdellah, Fez, Morocco
| | - Mustapha Maaroufi
- Radiology and Imaging Department, Centre Hospitalier Universitaire Hassan II, University Sidi Mohamed Ben Abdellah, Fez, Morocco
| | - Badreeddine Alami
- Radiology and Imaging Department, Centre Hospitalier Universitaire Hassan II, University Sidi Mohamed Ben Abdellah, Fez, Morocco
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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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Zhou Y, Lower EE. Balancing Altered Calcium Metabolism with Bone Health in Sarcoidosis. Semin Respir Crit Care Med 2020; 41:618-625. [PMID: 32777848 DOI: 10.1055/s-0040-1713009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Abnormal calcium metabolism in sarcoidosis patients can lead to hypercalcemia, hypercalciuria, and kidney stones. Hypercalcemia in sarcoidosis is usually due to increased activity of 1α-hydroxylase in macrophages of pulmonary granulomata, resulting in low levels of 25-hydroxyvitamin D and high levels of calcitriol. Vitamin D supplementation may be dangerous for some sarcoidosis patients and is recommended only for those with decreased 25-hydroxyvitamin D and reduced or normal calcitriol level. Diagnosis, treatment of osteoporosis, and maintenance of bone health are complex issues for sarcoidosis patients. An approach to diagnosis and treatment of bone fragility is presented.
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Affiliation(s)
- Ying Zhou
- Department of Respiratory Medicine, Clinical Research Center, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Elyse E Lower
- Department of Internal Medicine, University of Cincinnati Medical Center, Cincinnati, Ohio
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Ben Hassine I, Rein C, Comarmond C, Glanowski C, Saidenberg-Kermanac’h N, Meunier B, Schleinitz N, Chanson N, Sacré K, Scherlinger M, Richez C, Hirschi S, Groh M, Devilliers H, Bielefeld P, Saadoun D, Chapelon-Abric C, Arnaud L, Cacoub P. Osseous sarcoidosis: A multicenter retrospective case-control study of 48 patients. Joint Bone Spine 2019; 86:789-793. [DOI: 10.1016/j.jbspin.2019.07.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Accepted: 07/16/2019] [Indexed: 10/26/2022]
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Stjepanovic MI, Mihailovic-Vucinic V, Spasovski V, Milin-Lazovic J, Skodric-Trifunovic V, Stankovic S, Andjelkovic M, Komazec J, Momcilovic A, Santric-Milicevic M, Pavlovic S. Genes and metabolic pathway of sarcoidosis: identification of key players and risk modifiers. Arch Med Sci 2019; 15:1138-1146. [PMID: 31572458 PMCID: PMC6764301 DOI: 10.5114/aoms.2018.79682] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2018] [Accepted: 10/17/2018] [Indexed: 12/19/2022] Open
Abstract
INTRODUCTION Sarcoidosis is a rare multisystem granulomatous disease with unknown etiology. The interplay of vitamin D deficiency and genetic polymorphisms in genes coding for the proteins relevant for metabolism of vitamin D is an important, but unexplored area. The aim of this study was to investigate the association between single nucleotide polymorphisms (SNPs) in CYP2R1 (rs10741657), CYP27B1 (rs10877012), DBP (rs7041; rs4588), and VDR (rs2228570) genes and sarcoidosis, as well as the association between these SNPs and 25(OH)D levels in sarcoidosis patients. MATERIAL AND METHODS For that purpose we genotyped 86 sarcoidosis patients and 50 healthy controls using the PCR-RFLP method. RESULTS Subjects carrying the CC genotype of CYP27B1 rs10877012 have 10 times lower odds of suffering from sarcoidosis. Moreover, DBP rs4588 AA genotype was shown to be a susceptibility factor, where carriers of this genotype had eight times higher odds for developing sarcoidosis. In addition, the A allele of the DBP gene (rs4588) was associated with lower levels of 25(OH)D in sarcoidosis patients. CONCLUSIONS These results suggest that patients with vitamin D deficiency should be regularly tested for genetic modifiers that are related to sarcoidosis in order to prevent development of serious forms of sarcoidosis.
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Affiliation(s)
- Mihailo I. Stjepanovic
- Clinic of Pulmonology, Clinical Center of Serbia, Belgrade, Serbia
- Medical Faculty, University of Belgrade, Belgrade, Serbia
| | - Violeta Mihailovic-Vucinic
- Clinic of Pulmonology, Clinical Center of Serbia, Belgrade, Serbia
- Medical Faculty, University of Belgrade, Belgrade, Serbia
| | - Vesna Spasovski
- Institute of Molecular Genetics and Genetic Engineering, University of Belgrade, Belgrade, Serbia
| | | | - Vesna Skodric-Trifunovic
- Clinic of Pulmonology, Clinical Center of Serbia, Belgrade, Serbia
- Medical Faculty, University of Belgrade, Belgrade, Serbia
| | - Sanja Stankovic
- Center for Medical Biochemistry, Clinical Center of Serbia, Belgrade, Serbia
| | - Marina Andjelkovic
- Institute of Molecular Genetics and Genetic Engineering, University of Belgrade, Belgrade, Serbia
| | - Jovana Komazec
- Institute of Molecular Genetics and Genetic Engineering, University of Belgrade, Belgrade, Serbia
| | - Ana Momcilovic
- Institute of Molecular Genetics and Genetic Engineering, University of Belgrade, Belgrade, Serbia
| | - Milena Santric-Milicevic
- Medical Faculty, University of Belgrade, Belgrade, Serbia
- Institute of Social Medicine, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Sonja Pavlovic
- Institute of Molecular Genetics and Genetic Engineering, University of Belgrade, Belgrade, Serbia
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Shariatmaghani S, Salari R, Sahebari M, Tabrizi PS, Salari M. Musculoskeletal Manifestations of Sarcoidosis: A Review Article. Curr Rheumatol Rev 2019; 15:83-89. [PMID: 29692254 DOI: 10.2174/1573397114666180425111901] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2017] [Revised: 04/06/2018] [Accepted: 04/12/2018] [Indexed: 12/20/2022]
Abstract
BACKGROUND Sarcoidosis is a multisystem inflammatory disease with an etiology that is not clearly understood. Amongst the different organs that may be affected, the lungs are the most common. Musculoskeletal manifestations of the disease are uncommon. OBJECTIVES They include arthropathy, bone lesions, or myopathy, all of which may occur as initial symptoms or develop during the course of the disease. METHODS Articular involvement my present as arthralgia or arthritis. Skeletal complications usually develop in the chronic state of the disease. Muscular disease is rare and usually asymptomatic. Appropriate imaging modalities including X-ray, MRI, FDG-PET/CT assist in the diagnosis of rheumatic sarcoidosis. However, biopsy is necessary for definite diagnosis. RESULT AND CONCLUSION In most cases of musculoskeletal involvement, NSAIDs and corticosteroids are sufficient for symptomatic management. For more resistant cases immunosuppressive drugs (i.e., methotrexate) and TNF- inhibitors are used. Our aim is to review various types of musculoskeletal involvement in sarcoidosis and their existing treatment options.
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Affiliation(s)
- Somayeh Shariatmaghani
- Department of Internal Medicine, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Roshanak Salari
- Department of Clinical Persian Pharmacy, School of Persian and Complementary Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Maryam Sahebari
- Rheumatic Diseases Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Payman Shalchian Tabrizi
- Department of Internal Medicine, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Masoumeh Salari
- Rheumatic Diseases Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
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Abstract
PURPOSE OF REVIEW Sarcoidosis is a rare, multisystem granulomatous disease of incompletely understood pathogenesis. Clinically, it shares common features with several systemic and organ-specific autoimmune diseases, although known autoantibodies or useful serologic markers for diagnosis and monitoring of disease activity are lacking. Sarcoidosis can both coexist with or mimic connective tissue diseases or vasculitis. Here, we review possible common etiologic factors between sarcoidosis and autoimmune disease, comparing clinical, laboratory and imaging features. RECENT FINDINGS Autoimmune diseases may precede or follow the diagnosis of sarcoidosis. Overall, the prevalence of both co-existing is unknown because of limited evidence. The presence of autoantibodies in sarcoidosis should raise suspicion of an underlying autoimmune disease that mimics or co-occurs with sarcoidosis. Silica dust exposure has been associated with an increased prevalence of both sarcoidosis and rheumatoid arthritis. In another study, autoimmune thyroid disease, Sjogren's syndrome and ankylosing spondylitis have been reported to be more frequent in sarcoidosis compared with healthy controls. SUMMARY A systematic diagnostic work-up is necessary to detect overlapping disease features in patients with sarcoidosis. Immune-modulating therapies need to be taken into account as these can induce paradoxical reactions.
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Serum and urinary calcium level in Latvian patients with sarcoidosis. Reumatologia 2018; 56:377-381. [PMID: 30647484 PMCID: PMC6330682 DOI: 10.5114/reum.2018.80715] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Accepted: 12/03/2018] [Indexed: 12/19/2022] Open
Abstract
Objectives Sarcoidosis is a multisystem granulomatous disease of unknown etiology that in 90% of cases affects the lungs. Calcium metabolism testing can be useful in diagnostics. The aim of the study was to assess the correlation between calcium metabolism and sarcoidosis form of manifestation/demographic indicators. Material and methods In a retrospective study medical records of all patients (n = 699) who had been hospitalized with suspected sarcoidosis in a specialized clinic of Riga Eastern Clinical University Hospital during the period from January 1st, 2013 until December 31st, 2014 were analyzed. Further analysis included only patients with histologically and/or clinically confirmed sarcoidosis (n = 281). Results Patients’ average age at the time of diagnosis was 39 ±13 years. Elevated serum calcium was observed in 9.9% of cases. A statistically significant correlation was found between serum calcium and age (p < 0.01). There was an association between serum calcium and gender (p < 0.05) – levels were higher in men (2.43 mmol/l) than in women (2.40 mmol/l). Elevated calcium in 24-hour urine was observed in 22.7% of patients. The mean value was 232.3 mg/24 h, levels were higher in men (258.7 mg/24 h) than in women (202.3 mg/24 h), and the association with gender was statistically significant (p < 0.01). Conclusions We can conclude that in Latvia sarcoidosis affects mostly young and middle-aged people. Both serum calcium and calcium in 24-hour urine are important parameters for sarcoidosis diagnostics. Hypercalcemia was found in 9.9% of patients, hypercalciuria in 22.7% of patients, and both were statistically significantly higher in men, regardless of age.
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Bone Mineral Loss and Fracture in Sarcoidosis: A Systematic Review and Meta-Analysis. Arch Rheumatol 2018; 34:130-140. [PMID: 31497759 DOI: 10.5606/archrheumatol.2019.6883] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Accepted: 06/03/2018] [Indexed: 12/31/2022] Open
Abstract
Objectives This meta-analysis aims to investigate the possibility of bone mineral loss and fracture in sarcoidosis. Materials and methods A comprehensive search of the MEDLINE and Embase databases was performed from inception through August 2017. The inclusion criterion was observational studies evaluating the association between sarcoidosis and bone mineral density (BMD) or fracture. The pooled odds ratio (OR) of fracture, standardized mean difference (SMD) of volumetric BMD and areal BMD, and their 95% confidence interval (CI) were calculated using a random-effects meta-analysis to compare risk between sarcoidosis and controls. The between-study heterogeneity of effect-size was quantified using the Q statistic and I2. Results Data were extracted from 10 studies involving a total of 6,448 sarcoidosis patients and 77,857 controls. The pooled result demonstrated no significant increased risk of fracture in sarcoidosis patients compared with controls (OR=1.68; 95% CI: 0.85-3.31, p value=0.14, I2=72%). There were no differences between the patients and controls in areal BMD (SMD= 0.21 g/cm2; 95% CI: -0.12-0.54, p value= 0.22, I2=0%) or volumetric BMD (SMD= 0.04 mg/cm3; 95% CI: -0.51-0.58, p value=0.89, I2=83%). Conclusion Our study has not shown an increased risk of fracture or bone mineral loss in sarcoidosis. However, based on the currently available studies with heterogeneity in between, the conclusion for the osteoporosis screening and fracture risk assessment of patients with sarcoidosis cannot be drawn until more studies are available.
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Papanikolaou IC, Tabila B, Tabila K, Borok Z, Sharma O, Gould MK. Vitamin D status in sarcoidosis: a cross-sectional study. SARCOIDOSIS VASCULITIS AND DIFFUSE LUNG DISEASES 2018; 35:154-159. [PMID: 32476896 DOI: 10.36141/svdld.v35i2.6199] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Accepted: 09/25/2017] [Indexed: 11/02/2022]
Abstract
Background: Hypercalcemia, a common feature in sarcoidosis, is due to the excessive production of active Vitamin D metabolite, 1,25(OH)2D. Levels of 25(OH) Vitamin D however may not be appropriate. Objectives: To assess Vitamin D status and its clinical associations in sarcoidosis patients compared to a general respiratory diseases out-patient clinic population, serving as controls. Methods: 64 sarcoidosis cases and 53 control cases with other than sarcoidosis respiratory diseases, matched for age and sex were included in the study. Serum 25(OH)D, 1,25(OH)2D, calcium, angiotensin converting enzyme (ACE) were measured. 25(OH) Vitamin D was described as deficient when <20 ng/ml and insufficient when <30 ng/ml. Clinical parameters were recorded for sarcoidosis cases. Results: Overall 41/64 sarcoidosis cases (64%) had low 25(OH) D, 7/64 (11%) had high 1,25(OH)2D and 2/64 had hypercalcaemia (3%). Sarcoidosis subjects likely exhibited deficient (39%) or normal 25(OH)D levels (36%) in comparison to controls (p=0.018). 25(OH) Vitamin D deficiency in sarcoidosis was associated with race and radiological stage I disease, with regression analysis identifying African-American race as the only significant risk factor (p=0.03). An inverse correlation between ACE and 25(OH)D levels was found (p=0.052). 1,25(OH)2D was significantly elevated in sarcoidosis compared to controls. Among sarcoidosis patients, those with insufficient 25(OH)D levels exhibited higher calcium levels in serum. Conclusions: 25(OH) Vitamin D deficiency is prevalent in sarcoidosis, particularly in African-Americans and likely those with active disease. However, concomitant 1,25(OH)2D elevation and associated hypercalcaemia make Vitamin D supplementation dangerous in sarcoidosis. (Sarcoidosis Vasc Diffuse Lung Dis 2018; 35: 154-159).
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Affiliation(s)
- Ilias C Papanikolaou
- Division of Pulmonary, Critical Care and Sleep Medicine, Keck School of Medicine, University of Southern California, USA.,Department of Pulmonary Medicine, Corfu General Hospital, Greece
| | - Brian Tabila
- Division of Pulmonary, Critical Care and Sleep Medicine, Keck School of Medicine, University of Southern California, USA
| | | | - Zea Borok
- Will Rogers Institute Pulmonary Research Center, Division of Pulmonary, Critical Care and Sleep Medicine, Keck School of Medicine, University of Southern California, USA
| | - Om Sharma
- Division of Pulmonary, Critical Care and Sleep Medicine, Keck School of Medicine, University of Southern California, USA
| | - Michael K Gould
- Health Services Research and Implementation Science, Kaiser Permanente Southern California
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Kiani A, Abedini A, Adcock IM, Mirenayat MS, Taghavi K, Mortaz E, Kazempour-Dizaji M. Association Between Vitamin D Deficiencies in Sarcoidosis with Disease Activity, Course of Disease and Stages of Lung Involvements. J Med Biochem 2018; 37:103-109. [PMID: 30581345 PMCID: PMC6294100 DOI: 10.1515/jomb-2017-0041] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2017] [Accepted: 07/28/2017] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Despite negative association between 25-hydroxy vitamin D and incidence of many chronic respiratory diseases, this feature was not well studied in sarcoidosis. Current study investigated the association between 25-hydroxy vitamin D deficiency with sarcoidosis chronicity, disease activity, extra-pulmonary skin manifestations, urine calcium level and pulmonary function status in Iranian sarcoidosis patients. Results of this study along with future studies, will supply more effective programs for sarcoidosis treatment. METHODS Eighty sarcoidosis patients in two groups of insufficient serum level and sufficient serum level of 25-hydroxy vitamin D were studied. Course of sarcoidosis was defined as acute and chronic sarcoidosis. Pulmonary function test (PFT) was assessed by spirometry. Skin involvements were defined as biopsy proven skin sarcoidosis. 24-hour urine calcium level was used to specify the disease activity. Stages of lung involvements were obtained by CT-scan and chest X-ray. The statistical analyses were evaluated using Statistical Package for the Social Sciences. RESULTS A significant negative correlation was obtained between vitamin D deficiency in sarcoidosis patients and disease chronic course and stages two to four of lung involvements. Considering other parameters of the disease and vitamin D deficiency, no significant correlation was detected. CONCLUSIONS In conclusion, results of the current study implies in the role of vitamin 25(OH)D deficiencies in predicting the course of chronic sarcoidosis. Furthermore, it was concluded that vitamin 25(OH)D deficiency can direct pulmonary sarcoidosis toward stage 2-4 of lung involvements.
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Affiliation(s)
- Arda Kiani
- Tracheal Diseases Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Atefeh Abedini
- Chronic Respiratory Diseases Research Center, National Research Institute of Tuberculosis and Lung Disease (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Ian M. Adcock
- Cell and Molecular Biology Group, Airways Disease Section, National Heart and Lung Institute, Imperial College London, Dove house Street, London, UK. 10
- Priority Research Centre for Healthy Lungs, Hunter Medical Research Institute, The University of Newcastle, Newcastle, New South Wales, Australia
| | - Maryam Sadat Mirenayat
- Chronic Respiratory Diseases Research Center, National Research Institute of Tuberculosis and Lung Disease (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Kimia Taghavi
- Chronic Respiratory Diseases Research Center, National Research Institute of Tuberculosis and Lung Disease (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Esmaeil Mortaz
- Department of Immunology, Faculty of Medicine, Clinical Tuberculosis and Epidemiology Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mehdi Kazempour-Dizaji
- Mycobacteriology Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Masih Daneshvari Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Abstract
Musculoskeletal manifestations in the context of sarcoidosis are frequently observed. The rheumatologist regularly encounters this disease in clinical practice. In the present review, we aim to give a current overview of the manifestations and treatments relevant to the practicing rheumatologist. The most frequently encountered manifestation is Lofgren's syndrome, which is characterized by bilateral ankle periarthritis, bilateral hilar lymphadenopathy, and erythema nodosum and has an excellent prognosis. Chronic arthropathy most commonly manifests as oligoarthritis, which sometimes hampers its differentiation from spondylarthropathies, especially when sacroiliitis, enthesitis or dactylitis are simultaneously present. Isolated vertebral granulomas are rare and require infectious and malignant disorders to be excluded, since there are no specific imaging findings that are exclusively found in vertebral sarcoidosis. The presence of granulomas in skeletal muscle is common in muscle biopsies, whereas clinically overt myopathy is present in only around 1-2% of patients. Therapeutic responses vary among the different clinical phenotypes. Non-steroidal anti-inflammatory drugs and low to medium dose glucocorticoids are the first-line therapy for musculoskeletal manifestations and often lead to adequate disease control in acute sarcoidosis. When these are ineffective or not tolerated, steroid-sparing agents are increasingly used in chronic sarcoidosis. Evidence for all medications used in sarcoid-related arthritis is comparatively scant. When supplementing vitamin D, the possible development of hypercalcemia, even at standard doses, needs to be considered; the optimal therapeutic levels for the prevention of medication-induced osteoporosis in sarcoidosis have not been firmly established.
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Affiliation(s)
- P Korsten
- Klinik für Nephrologie und Rheumatologie, Universitätsmedizin Göttingen, Robert-Koch-Str. 40, 37075, Göttingen, Deutschland.
| | - G Chehab
- Poliklinik, Funktionsbereich und Hiller Forschungszentrum für Rheumatologie, Universitätsklinikum der Heinrich-Heine-Universität Düsseldorf, Düsseldorf, Deutschland
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Abstract
Advanced imaging has demonstrated that musculoskeletal manifestations of systemic sarcoidosis are more common than previously thought. A definitive strategy for the management of osseous sarcoidosis has not been defined. Some lesions resolve spontaneously, and no systemic medication for sarcoidosis consistently resolves lesions. The orthopaedic surgeon treating patients with musculoskeletal sarcoidosis must make an appropriate diagnosis of bony lesions, seek multidisciplinary input from specialists in pulmonology and rheumatology regarding systemic treatment, and decide when surgery is necessary to prevent dysfunction.
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Brito-Zerón P, Acar-Denizli N, Sisó-Almirall A, Bosch X, Hernández F, Vilanova S, Villalta M, Kostov B, Paradela M, Sanchez M, Ramírez J, Muxí A, Berruezo A, Galceran-Chaves C, Xaubet A, Agustí C, Sellarés J, Ramos-Casals M. The Burden of Comorbidity and Complexity in Sarcoidosis: Impact of Associated Chronic Diseases. Lung 2017; 196:239-248. [PMID: 29230534 DOI: 10.1007/s00408-017-0076-4] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Accepted: 12/04/2017] [Indexed: 12/17/2022]
Abstract
PURPOSE To evaluate comorbidity, complexity and poor outcomes in patients with sarcoidosis and to compare those scores with a control group. METHODS 218 consecutive patients were diagnosed with sarcoidosis according to the ATS/ERS/WASOG criteria; extrathoracic involvement was evaluated using the 2014 WASOG organ assessment instrument. Sarcoidosis patients were compared with an age- and gender-matched control group of primary care outpatients without sarcoidosis. Comorbidities were assessed retrospectively using the Charlson Comorbidity Index (CCI); complexity was evaluated according to the classification into Clinical Risk Groups (CRG) and severity levels. RESULTS The cohort included 142 women and 76 men; the mean age was 47.1 years at diagnosis of sarcoidosis and 55.9 years at the last visit. Patients with a CCI > 1 had a higher frequency of calcium/vitamin D abnormalities (p < 0.001), kidney involvement (p = 0.005) and a higher mortality rate (p < 0.001) compared with patients with a CCI ≤ 1. Patients with a CRG ≥ 6 had a higher frequency of extrathoracic involvement (p = 0.039), calcium/vitamin D abnormalities (p = 0.019) and treatment with glucocorticoids (p = 0.032) compared with patients with a CRG < 6. 11% patients died after a mean follow-up of 102.3 months. Country of birth, kidney involvement and extrathoracic disease were significantly associated with death. Patients with sarcoidosis had a higher frequency of liver (p < 0.001), pulmonary (p = 0.002) and autoimmune disease (p = 0.011) and cancer (p = 0.007) compared with the control group. CONCLUSION We found higher rates of comorbidity and complexity in patients with sarcoidosis compared with a control group. Liver, pulmonary, autoimmune and neoplastic diseases were the main comorbidities found in patients with sarcoidosis.
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Affiliation(s)
- Pilar Brito-Zerón
- Laboratory of Systemic Autoimmune Diseases "Josep Font", CELLEX, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Department of Systemic Autoimmune Diseases, ICMID, Hospital Clinic, C/Villarroel, 170, 08036, Barcelona, Spain.,Autoimmune Diseases Unit, Department of Internal Medicine, Hospital CIMA-Sanitas, Barcelona, Spain
| | - Nihan Acar-Denizli
- Department of Statistics, Faculty of Science and Letters, Mimar Sinan Fine Arts University, Istanbul, Turkey
| | - Antoni Sisó-Almirall
- Primary Healthcare Transversal Research Group, IDIBAPS, Primary Care Center Les Corts, CAPSBE, Barcelona, Spain
| | - Xavier Bosch
- Quick Diagnosis Unit, Department of Internal Medicine, ICMID, Hospital Clinic, Barcelona, Spain
| | | | - Sergi Vilanova
- Primary Healthcare Transversal Research Group, IDIBAPS, Primary Care Center Les Corts, CAPSBE, Barcelona, Spain
| | - Mireia Villalta
- Primary Healthcare Transversal Research Group, IDIBAPS, Primary Care Center Les Corts, CAPSBE, Barcelona, Spain
| | - Belchin Kostov
- Primary Healthcare Transversal Research Group, IDIBAPS, Primary Care Center Les Corts, CAPSBE, Barcelona, Spain
| | - Marina Paradela
- Department of Thoracic Surgery, Hospital Clinic, Barcelona, Spain
| | | | - José Ramírez
- Department of Pathology, Hospital Clinic, Barcelona, Spain
| | - Africa Muxí
- Department of Nuclear Medicine, Hospital Clínic, Barcelona, Spain
| | - Antonio Berruezo
- Department of Cardiology, ICCV, Hospital Clínic, Barcelona, Catalonia, Spain
| | - Celeste Galceran-Chaves
- Department of Child and Adolescent Psychiatry and Psychology, Hospital Clínic, Barcelona, Spain
| | - Antoni Xaubet
- Department of Pneumology, ICR, Hospital Clinic, Barcelona, Spain
| | - Carles Agustí
- Department of Pneumology, ICR, Hospital Clinic, Barcelona, Spain
| | - Jacobo Sellarés
- Department of Pneumology, ICR, Hospital Clinic, Barcelona, Spain
| | - Manuel Ramos-Casals
- Laboratory of Systemic Autoimmune Diseases "Josep Font", CELLEX, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Department of Systemic Autoimmune Diseases, ICMID, Hospital Clinic, C/Villarroel, 170, 08036, Barcelona, Spain.
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Kemah B, Özturan B, Bilgic B, Özkan K, Akpınar F, Kılıc B. An Unusual Orthopaedic Disease: Sarcoidosis-A Case Report. Surg J (N Y) 2017; 3:e75-e78. [PMID: 28825025 PMCID: PMC5553517 DOI: 10.1055/s-0037-1601879] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Accepted: 02/23/2017] [Indexed: 11/29/2022] Open
Abstract
Sarcoidosis is an idiopathic, noncaseating granulomatous disorder with wide systemic involvement. It is encountered widely around the world and it affects both sexes, all the races in all age groups. Lungs, eyes, and skin are the organs most commonly affected. Constitutional features such as weight loss, fatigue, and myalgia are the most common symptoms. Bone involvement, which is very rare, was reported as present in 3 to 13% of effected cases, and it is most commonly seen in hands and feet, compared with long bone involvement, which is extremely rare. We hereby present a case with a diagnosis of sarcoidosis and multiple bone involvement emphasizing the importance of differential diagnosis.
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Affiliation(s)
- Bahattin Kemah
- Department of Orthopaedics and Traumatology, Agri State Hospital, Agri, Turkey
| | - Burak Özturan
- Department of Orthopaedics and Traumatology, Istanbul Medeniyet University Göztepe Training and Research Hospital, Istanbul, Turkey
| | - Bilge Bilgic
- Department of Pathology, Istanbul Medicine Faculty, Istanbul University, Istanbul, Turkey
| | - Korhan Özkan
- Department of Orthopaedics and Traumatology, Istanbul Medeniyet University Göztepe Training and Research Hospital, Istanbul, Turkey
| | - Fuat Akpınar
- Department of Orthopaedics and Traumatology, Istanbul Medeniyet University Göztepe Training and Research Hospital, Istanbul, Turkey
| | - Bulent Kılıc
- Department of Orthopaedics and Traumatology, Istanbul Gelisim University, Istanbul, Turkey
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Zhou Y, Lower EE, Li H, Farhey Y, Baughman RP. Clinical characteristics of patients with bone sarcoidosis. Semin Arthritis Rheum 2017; 47:143-148. [PMID: 28274482 DOI: 10.1016/j.semarthrit.2017.02.004] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Revised: 01/26/2017] [Accepted: 02/04/2017] [Indexed: 01/13/2023]
Abstract
OBJECTIVE To assess the clinical features, diagnosis, and treatment of bone sarcoidosis in the United States. METHODS Patients with bone sarcoidosis were identified and matched to sarcoidosis patients based on race, gender, and age. Detailed characteristics were obtained by medical record review. RESULTS A total of 64 patients with bone sarcoidosis were enrolled in this study. The female:male ratio was 1.46:1 and the white:black ratio was 3:1. Thirty-eight (59.4%) of 64 patients had bone symptoms. Compared to matched cases, bone sarcoidosis patients have more multi-organ involvement and higher incidence with liver, spleen, and extrathoracic lymph node involvement than controls (P < 0.05). Spine was the most commonly affected bone in 44 (68.8%) of patients, followed by pelvis (35.9%), and hands (15.6%). MRI and PET/CT scan was the common imaging technology, which performed in 36 patients and 32 patients, respectively, and with 97.2% and 93.8% positive bone uptake. Laboratory test indicated anemia was more common in bone sarcoidosis group than controls (P = 0.044). Infliximab was more commonly used in bone sarcoidosis patients than controls (P = 0.009). CONCLUSION Bone sarcoidosis was associated with multi-organs affection, and high frequency of liver, spleen, or extrathoracic lymph node involvement. Infliximab should be considered in those patients with aggressive and refractory bone sarcoidosis.
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Affiliation(s)
- Ying Zhou
- Department of Internal Medicine, University of Cincinnati Medical Center, 1001 Holmes, Eden Ave, Cincinnati, OH 45267; Department of Respiratory Medicine, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Elyse E Lower
- Department of Internal Medicine, University of Cincinnati Medical Center, 1001 Holmes, Eden Ave, Cincinnati, OH 45267
| | - Huiping Li
- Department of Respiratory Medicine, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Yolanda Farhey
- Department of Internal Medicine, University of Cincinnati Medical Center, 1001 Holmes, Eden Ave, Cincinnati, OH 45267
| | - Robert P Baughman
- Department of Internal Medicine, University of Cincinnati Medical Center, 1001 Holmes, Eden Ave, Cincinnati, OH 45267.
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Nureki SI, Miyazaki E, Yamasue M, Takenaka R, Ando M, Kadota JI. Intrascrotal and osseous sarcoidosis mimicking intrascrotal organ cancer and bony metastasis. SARCOIDOSIS VASCULITIS AND DIFFUSE LUNG DISEASES 2017; 34:373-379. [PMID: 32476871 DOI: 10.36141/svdld.v34i4.5523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 06/13/2016] [Accepted: 06/29/2017] [Indexed: 11/02/2022]
Abstract
We report a case of sarcoidosis with concomitant epididymis, testes, and phalanxes involvement mimicking intrascrotal organ cancer and metastatic bony disease. A 23-year-old man developed blurred vision and hyperemia of the left eye, and was diagnosed as having left iritis. A chest computed tomography scan detected bilateral hilar lymphadenopathy and lung nodular shadows. A transbronchial lung biopsy revealed a non-caseating granuloma and he was diagnosed with sarcoidosis. One year after the onset of his eye symptoms, he noticed enlargement of his right scrotum. Magnetic resonance imaging detected lesions of the right epididymis, bilateral testes, and bilateral phalanxes. A technetium-99m scintigram revealed a high accumulation in the bilateral bones of extremities. These radiological findings mimicked intrascrotal organ cancer and metastatic bony disease. Pathologic evaluation following the right epididymectomy revealed non-caseating granulomas compatible with sarcoidosis. Three and half years after the appearance of intrascrotal and bony lesions, they improved spontaneously. (Sarcoidosis Vasc Diffuse Lung Dis 2017; 34: 373-376).
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Affiliation(s)
| | - Eishi Miyazaki
- Center for Community Medicine, Oita University Faculty of Medicine, 1-1 Idaigaoka, Hasama-machi, Yufu, Oita 879-5593, Japan
| | - Mari Yamasue
- Department of Respiratory Medicine and Infectious Diseases and
| | | | - Masaru Ando
- Department of Respiratory Medicine and Infectious Diseases and
| | - Jun-Ichi Kadota
- Department of Respiratory Medicine and Infectious Diseases and
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Sodhi A, Aldrich T. Vitamin D Supplementation: Not So Simple in Sarcoidosis. Am J Med Sci 2016; 352:252-7. [DOI: 10.1016/j.amjms.2016.05.027] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Revised: 05/24/2016] [Accepted: 05/25/2016] [Indexed: 11/29/2022]
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A functional proteomics approach to the comprehension of sarcoidosis. J Proteomics 2015; 128:375-87. [PMID: 26342673 DOI: 10.1016/j.jprot.2015.08.012] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2015] [Revised: 07/30/2015] [Accepted: 08/19/2015] [Indexed: 12/22/2022]
Abstract
Pulmonary sarcoidosis (Sar) is an idiopathic disease histologically typified by non-caseating epitheliod cell sarcoid granulomas. A cohort of 37 Sar patients with chronic persistent pulmonary disease was described in this study. BAL protein profiles from 9 of these Sar patients were compared with those from 8 smoker (SC) and 10 no-smoker controls (NSC) by proteomic approach. Principal Component Analysis was performed to clusterize the samples in the corresponding conditions highlighting a differential pattern profiles primarily in Sar than SC. Spot identification reveals thirty-four unique proteins involved in lipid, mineral, and vitamin Dmetabolism, and immuneregulation of macrophage function. Enrichment analysis has been elaborated by MetaCore, revealing 14-3-3ε, α1-antitrypsin, GSTP1, and ApoA1 as "central hubs". Process Network as well as Pathway Maps underline proteins involved in immune response and inflammation induced by complement system, innate inflammatory response and IL-6signalling. Disease Biomarker Network highlights Tuberculosis and COPD as pathologies that share biomarkers with sarcoidosis. In conclusion, Sar protein expression profile seems more similar to that of NSC than SC, conversely to other ILDs. Moreover, Disease Biomarker Network revealed several common features between Sar and TB, exhorting to orientate the future proteomics investigations also in comparative BALF analysis of Sar and TB.
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Goldilocks, vitamin D and sarcoidosis. Arthritis Res Ther 2015; 16:111. [PMID: 25166268 PMCID: PMC4060200 DOI: 10.1186/ar4568] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2014] [Accepted: 05/14/2014] [Indexed: 01/30/2023] Open
Abstract
While low levels of vitamin D can increase the risk for osteoporosis, excessive amounts of vitamin D may also be problematic. Hypercalcemia and hypercalcuria due to increased vitamin D activity occur in a significant proportion of sarcoidosis patients. Saidenberg-Kermanac’h and colleagues compared vitamin D levels with bone fragility fractures in their sarcoidosis clinic. They found that a 25-(OH) vitamin D level between 10 and 20 ng/ml was associated with the lowest risk of bone fractures and paradoxically higher levels increased the risk of bone fractures. Using less vitamin D supplementation may simultaneously lower the risk for bone fracture and hypercalcemia in sarcoidosis.
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TREM-2 Receptor Expression Increases with 25(OH)D Vitamin Serum Levels in Patients with Pulmonary Sarcoidosis. Mediators Inflamm 2015; 2015:181986. [PMID: 26166951 PMCID: PMC4488005 DOI: 10.1155/2015/181986] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2014] [Revised: 05/08/2015] [Accepted: 05/18/2015] [Indexed: 11/17/2022] Open
Abstract
TREM-1 and TREM-2 molecules are members of the TREM transmembrane glycoproteins. In our previous study we identified increased expressions of TREM-1 and TREM-2 receptors in pulmonary sarcoidosis (PS). Only a few studies concerning the association between vitamin D and TREM receptor expression can be found. The aim of our current study was to determine the association between the levels of an inactive form of 25(OH)D vitamin and TREM-1 and TREM-2 receptor expressions. We have detected low levels of 25(OH)D vitamin in 79% of PS patients. Only 21% of patients had normal serum level of 25(OH)D vitamin with values clustered within the low-normal range. The most striking findings were the increased TREM-2 expressions on myeloid cells surfaces in BALF of PS patients with normal 25(OH)D vitamin serum levels compared with those with its decreased levels. The total number of TREM-2 positive cells was 5.7 times higher and the percentage of TREM-2 positive cells was also significantly increased in BALF of PS patients with normal compared to PS patients with low 25(OH)D vitamin serum levels. A significant correlation between total TREM-2 expression and vitamin D levels has been detected too. However, we have not detected similar differences in TREM-1expression and 25(OH)D vitamin serum levels.
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Bolland MJ, Wilsher ML, Grey A, Horne AM, Fenwick S, Gamble GD, Reid IR. Bone density is normal and does not change over 2 years in sarcoidosis. Osteoporos Int 2015; 26:611-6. [PMID: 25172384 DOI: 10.1007/s00198-014-2870-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2014] [Accepted: 08/21/2014] [Indexed: 10/24/2022]
Abstract
SUMMARY Small studies have previously suggested that sarcoidosis may be associated with low bone mineral density. In this observational study of 64 patients with sarcoidosis, bone mineral density was within the normal range at baseline, and there was no evidence of accelerated bone loss over 1-2 years. INTRODUCTION Several small studies have suggested that sarcoidosis may be associated with low bone mineral density (BMD). METHODS We undertook a cross-sectional study of BMD in 64 patients with sarcoidosis. Of these, 27 with 25-hydroxyvitamin D<50 nmol/L entered a 1-year intervention study of vitamin D supplements, and 37 entered a 2-year longitudinal study of BMD, with the primary endpoint of the change in lumbar spine BMD. RESULTS The mean age of participants was 58 years, 68% were female, and 8% were currently using oral glucocorticoids. At baseline, BMD for the entire cohort was greater than the expected values for the population at the lumbar spine (mean Z-score 0.7, P<0.001) and total body (0.5, P<0.001) and similar to expected values at the femoral neck (0.2, P=0.14) and total hip (0.2, P=0.14). BMD did not change at any of these four sites (P>0.19) over 2 years in the longitudinal study. In the intervention study, vitamin D supplements had no effect on BMD, and therefore we pooled the data from all participants. BMD did not change over 1 year at the spine, total hip, or femoral neck (P>0.3), but decreased by 0.7% (95% confidence interval 0.3-1.1) at the total body (P=0.019). CONCLUSIONS BMD was normal at baseline, and there was no consistent evidence of accelerated bone loss over 1-2 years, regardless of baseline vitamin D status. Patients with sarcoidosis not using oral glucocorticoids do not need routine monitoring of BMD.
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Affiliation(s)
- M J Bolland
- Department of Medicine, University of Auckland, Private Bag 92 019, Auckland, 1142, New Zealand,
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Nessrine A, Zahra AF, Taoufik H. Musculoskeletal involvement in sarcoidosis. J Bras Pneumol 2014; 40:175-82. [PMID: 24831403 PMCID: PMC4083650 DOI: 10.1590/s1806-37132014000200012] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2013] [Accepted: 02/21/2014] [Indexed: 01/30/2023] Open
Abstract
Sarcoidosis is a multisystem inflammatory disorder of unknown cause. It most commonly
affects the pulmonary system but can also affect the musculoskeletal system, albeit
less frequently. In patients with sarcoidosis, rheumatic involvement is polymorphic.
It can be the presenting symptom of the disease or can appear during its progression.
Articular involvement is dominated by nonspecific arthralgia, polyarthritis, and
Löfgren's syndrome, which is defined as the presence of lung adenopathy, arthralgia
(or arthritis), and erythema nodosum. Skeletal manifestations, especially dactylitis,
appear mainly as complications of chronic, multiorgan sarcoidosis. Muscle involvement
in sarcoidosis is rare and usually asymptomatic. The diagnosis of rheumatic
sarcoidosis is based on X-ray findings and magnetic resonance imaging findings,
although the definitive diagnosis is made by anatomopathological study of biopsy
samples. Musculoskeletal involvement in sarcoidosis is generally relieved with
nonsteroidal anti-inflammatory drugs or corticosteroids. In corticosteroid-resistant
or -dependent forms of the disease, immunosuppressive therapy, such as treatment with
methotrexate or anti-TNF-α, is employed. The aim of this review was to present an
overview of the various types of osteoarticular and muscle involvement in
sarcoidosis, focusing on their diagnosis and management.
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Amin EN, Closser DR, Crouser ED. Current best practice in the management of pulmonary and systemic sarcoidosis. Ther Adv Respir Dis 2014; 8:111-132. [PMID: 25034021 DOI: 10.1177/1753465814537367] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
Sarcoidosis is a systemic inflammatory disease of unknown etiology that is characterized by the presence of granulomatous inflammation in affected tissues. It can affect essentially any organ system but shows a predilection for the lungs, eyes, and skin. Accurate epidemiological data are not available in the USA, but sarcoidosis is considered a 'rare disease' (prevalence less than 200,000). However, recent epidemiologic studies indicate that regional prevalence is much higher than previously estimated, especially among African American women. Additionally, mortality rates of patients with sarcoidosis are increasing by 3% per year over the past two decades. The most common causes of death are attributed to progressive lung disease and cardiac sarcoidosis, and the health of the patients is further compromised by other systemic manifestations. As such, the management of sarcoidosis requires a collaborative multidisciplinary approach. We aim to discuss the principles of managing sarcoidosis, including standards of care relating to pulmonary disease as well as recent advances relating to the detection and treatment of extrapulmonary manifestations.
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Affiliation(s)
- Emily N Amin
- Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Ohio State University, Columbus, OH, USA
| | - Douglas R Closser
- Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Ohio State University, Columbus, OH, USA
| | - Elliott D Crouser
- 201F Davis Heart and Lung Research Institute, 473 West 12th Avenue, Columbus, OH 43210, USA
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Hilderson I, Van Laecke S, Wauters A, Donck J. Treatment of renal sarcoidosis: is there a guideline? Overview of the different treatment options. Nephrol Dial Transplant 2013; 29:1841-7. [DOI: 10.1093/ndt/gft442] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
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Bolland MJ, Wilsher ML, Grey A, Horne AM, Fenwick S, Gamble GD, Reid IR. Randomised controlled trial of vitamin D supplementation in sarcoidosis. BMJ Open 2013; 3:e003562. [PMID: 24157819 PMCID: PMC3808783 DOI: 10.1136/bmjopen-2013-003562] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES The role vitamin D intake/production plays in sarcoidosis-associated hypercalcaemia is uncertain. However, authoritative reviews have recommended avoiding sunlight exposure and vitamin D supplements, which might lead to adverse skeletal outcomes from vitamin D insufficiency. We investigated the effects of vitamin D supplementation on surrogate measures of skeletal health in patients with sarcoidosis and vitamin D insufficiency. DESIGN Randomised, placebo-controlled trial. SETTING Clinical research centre. PARTICIPANTS 27 normocalcaemic patients with sarcoidosis and 25-hydroxyvitamin D (25OHD) <50 nmol/L. INTERVENTION 50 000 IU weekly cholecalciferol for 4 weeks, then 50 000 IU monthly for 11 months or placebo. PRIMARY AND SECONDARY OUTCOME MEASURES The primary endpoint was the change in serum calcium over 12 months, and secondary endpoints included measurements of calcitropic hormones, bone turnover markers and bone mineral density (BMD). RESULTS The mean age of participants was 57 years and 70% were women. The mean (SD) screening 25OHD was 35 (12) and 38 (9) nmol/L in the treatment and control groups, respectively. Vitamin D supplementation increased 25OHD to 94 nmol/L after 4 weeks, 84 nmol/L at 6 months and 78 nmol/L at 12 months, while levels remained stable in the control group. 1,25-Dihydroxy vitamin D levels were significantly different between the groups at 4 weeks, but not at 6 or 12 months. There were no between-groups differences in albumin-adjusted serum calcium, 24 h urine calcium, markers of bone turnover, parathyroid hormone or BMD over the trial. One participant developed significant hypercalcaemia after 6 weeks (total cholecalciferol dose 250 000 IU). CONCLUSIONS In patients with sarcoidosis and 25OHD <50 nmol/L, vitamin D supplements did not alter average serum calcium or urine calcium, but had no benefit on surrogate markers of skeletal health and caused one case of significant hypercalcaemia. TRIAL REGISTRATION This trial is registered at the Australian New Zealand Clinical Trials Registry (http://www.anzctr.org.au). The registration number is ACTRN12607000364471, date of registration 5/7/2007.
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Affiliation(s)
- Mark J Bolland
- Department of Medicine, University of Auckland, Auckland, New Zealand
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Haimovic A, Sanchez M, Judson MA, Prystowsky S. Sarcoidosis: A comprehensive review and update for the dermatologist. J Am Acad Dermatol 2012; 66:719.e1-10; quiz 729-30. [DOI: 10.1016/j.jaad.2012.02.003] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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