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Judson MA. Health-Related Quality of Life Assessment in Sarcoidosis. Clin Chest Med 2024; 45:159-173. [PMID: 38245364 DOI: 10.1016/j.ccm.2023.08.009] [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
Health-related quality of life (HRQoL) is of major concern to patients with sarcoidosis. HRQoL impairment is the most common reason to treat the disease. Advances in patient-reported outcome (PRO) methodology offer the promise to use these instruments to follow quality of life in individual patients with sarcoidosis over time. Several HRQoL issues will be highlighted including their clinical importance, common causes in patients with sarcoidosis, the construction and use of PROs in clinical sarcoidosis trials, methods to adapt PROs to monitor HRQoL in individual patients with sarcoidosis, and the approach to improving HRQoL in this disease.
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Affiliation(s)
- Marc A Judson
- Division of Pulmonary and Critical Care Medicine, Albany Medical Center, 16 New Scotland Avenue, MC-91 Division Pulm-CCM, Albany, NY 12208, USA.
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2
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Hilker C, Weis J, Ziehfreund S, Arkema EV, Biedermann T, Zink A. "The chameleon among diseases" - an explorative view of sarcoidosis and identification of the consequences for affected patients and relatives using qualitative interviews. Orphanet J Rare Dis 2023; 18:276. [PMID: 37679829 PMCID: PMC10486085 DOI: 10.1186/s13023-023-02866-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Accepted: 08/23/2023] [Indexed: 09/09/2023] Open
Abstract
INTRODUCTION Sarcoidosis is a multisystemic disease, with the lungs being the main site of manifestation. Although the exact etiology remains unclear, both genetic and environmental factors are being discussed. Diagnostic evaluation is challenging, and the management of chronic patients and assessment of their needs proves difficult, especially in the absence of targeted therapy. Studies on sarcoidosis patients have shown that quality of life is limited even after clinically measurable parameters have resolved. The question remains how patients and their relatives perceive medical care and the diagnostic process and how these affect their well-being. METHODS Qualitative, semi-structured interviews were conducted with patients and their relatives between September 2019 and February 2020. Interviews were recorded, transcribed verbatim, and analyzed using qualitative content analysis. Deductive hypotheses were then formed based on categories according to personal aspects, symptoms, diagnostic, daily life activity, therapy, psychological aspects and wishes. RESULTS Fourteen patients and five relatives were included. Most patients reported subacute symptoms before the first organ-related episode. A high degree of personal initiative was required from the majority of respondents in both the diagnostic and subsequent therapeutic processes. In addition, respondents reported so-called "doctor-hopping", a lack of specialists or contacts, and a lack of medical support. The Internet and self-help groups played a fundamental role for patients and relatives in exchanging information with other affected persons and to compensate for an existing information deficit. CONCLUSION The results provide new insights into patients' and relatives' perceptions of the sarcoidosis diagnosis and treatment process. Identification of barriers such as a lack of physicians and an information deficit highlights potential targets for strategies to optimize sarcoidosis management.
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Affiliation(s)
- Charlotte Hilker
- School of Medicine, Department of Dermatology and Allergy, Technical University of Munich, Biedersteiner Str. 29, 80802 Munich, Germany
| | - Johanna Weis
- School of Medicine, Department of Dermatology and Allergy, Technical University of Munich, Biedersteiner Str. 29, 80802 Munich, Germany
| | - Stefanie Ziehfreund
- School of Medicine, Department of Dermatology and Allergy, Technical University of Munich, Biedersteiner Str. 29, 80802 Munich, Germany
| | - Elizabeth V. Arkema
- Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Tilo Biedermann
- School of Medicine, Department of Dermatology and Allergy, Technical University of Munich, Biedersteiner Str. 29, 80802 Munich, Germany
| | - Alexander Zink
- School of Medicine, Department of Dermatology and Allergy, Technical University of Munich, Biedersteiner Str. 29, 80802 Munich, Germany
- Division of Dermatology and Venereology Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
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Hoth KF, Simmering J, Croghan A, Hamzeh NY. Cognitive Difficulties and Health-Related Quality of Life in Sarcoidosis: An Analysis of the GRADS Cohort. J Clin Med 2022; 11:jcm11133594. [PMID: 35806883 PMCID: PMC9267453 DOI: 10.3390/jcm11133594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 06/09/2022] [Accepted: 06/16/2022] [Indexed: 01/25/2023] Open
Abstract
Rationale: Subjective cognitive difficulties are common among sarcoidosis patients; however, previous studies have not modeled the link between cognitive difficulties and health-related quality of life (HRQOL). Objectives: To determine whether cognitive difficulties are associated with HRQOL in sarcoidosis patients after adjusting for demographics, fatigue, and physical disease severity measures. Methods: We performed a secondary analysis of the Genomic Research in Alpha-1 antitrypsin Deficiency and Sarcoidosis (GRADS) study data. We examined the association between self-reported cognitive difficulties (Cognitive Failures Questionnaire (CFQ)) and HRQOL (SF12v2 mental and physical component scores) while adjusting for the demographics, fatigue, and physical disease severity measures (i.e., organ involvement, forced vital capacity). Results: Approximately one-fourth of the patients with sarcoidosis endorsed cognitive difficulties. More frequent cognitive difficulties and more severe fatigue were significantly associated with worse mental HRQOL in the fully adjusted model, while older age was associated with better mental HRQOL. The association between cognitive difficulties and physical HRQOL was not significant in the final model. More severe fatigue, joint involvement, and reduced forced vital capacity (FVC) were associated with worse physical HRQOL, while higher income and higher education were associated with better physical HRQOL. Conclusions: Perceived cognitive difficulties are associated with diminished HRQOL after adjusting for demographics, organ involvement, pulmonary function, and fatigue. The association between cognitive difficulties and reduced HRQOL primarily occurs through the impact on mental components of HRQOL.
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Affiliation(s)
- Karin F. Hoth
- Department of Psychiatry, University of Iowa, Iowa City, IA 52242, USA; (K.F.H.); (A.C.)
- Iowa Neuroscience Institute, University of Iowa, Iowa City, IA 52242, USA
| | - Jacob Simmering
- Department of Internal Medicine, University of Iowa, Iowa City, IA 52242, USA;
| | - Anna Croghan
- Department of Psychiatry, University of Iowa, Iowa City, IA 52242, USA; (K.F.H.); (A.C.)
| | - Nabeel Y. Hamzeh
- Department of Internal Medicine, University of Iowa, Iowa City, IA 52242, USA;
- Correspondence: ; Tel.: +1-319-356-8343
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Judson MA, Yucel R, Preston S, Chen ES, Culver DA, Hamzeh N, Lower EE, Sweiss NJ, Valeyre D, Veltkamp M, Victorson DE, Beaumont JL, Singh N, Shivas T, Vancavage R, Baughman RP. The association of baseline sarcoidosis measurements with 6-month outcomes that are of interest to patients: Results from the On-line Sarcoidosis Assessment Platform Study (OSAP). Respir Med 2022; 196:106819. [DOI: 10.1016/j.rmed.2022.106819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Revised: 02/14/2022] [Accepted: 03/09/2022] [Indexed: 01/17/2023]
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Wilsher ML. Friend or foe? Corticosteroids in sarcoidosis. Respirology 2022; 27:190-191. [DOI: 10.1111/resp.14219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Accepted: 01/21/2022] [Indexed: 11/27/2022]
Affiliation(s)
- Margaret L. Wilsher
- Auckland District Health Board – Respiratory Auckland City Hospital Auckland New Zealand
- School of Medicine, Faculty of Medical and Health Sciences University of Auckland Auckland New Zealand
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Abstract
Health-related quality of life (HRQoL) describes an individual's perception of the impact of health, disease, and treatment on their quality of life (QoL). It is a reflection of how the manifestation of an illness and its treatment is personally experienced. Assessing HRQoL is particularly important in sarcoidosis because the attributable disease mortality is relatively low, and one of the major reasons for initiating treatment is to improve quality of life. HRQoL has been assessed in sarcoidosis using various generic and sarcoid-specific patient-reported outcome measures (PROMs). It is important that both the direct and indirect effects of the disease, as well as potential toxicities of therapy, are captured in the various PROMs used to assess HRQoL in sarcoidosis. This article provides a general overview of HRQoL in patients with sarcoidosis. It describes the various PROMs used to assess HRQoL in sarcoidosis and addresses the various factors that influence HRQoL in sarcoidosis. Specific attention is paid to fatigue, small fiber neuropathy, corticosteroid therapy, and other disease-specific factors that affect HRQoL in sarcoidosis. It also provides an insight into interventions that have been associated with improved HRQoL in sarcoidosis and offers suggestions for future research in this important area.
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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, North Carolina
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Vis R, van de Garde EMW, Meek B, Korenromp IHE, Grutters JC. Randomised, placebo-controlled trial of dexamethasone for quality of life in pulmonary sarcoidosis. Respir Med 2020; 165:105936. [PMID: 32308204 DOI: 10.1016/j.rmed.2020.105936] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Revised: 01/24/2020] [Accepted: 03/13/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Many patients with pulmonary sarcoidosis experience reduced quality of life. Although oral corticosteroids are the most common agents used in sarcoidosis, very little is known on the effects on quality of life. METHODS In this double-blind, placebo-controlled trial, newly diagnosed patients without an indication for high dose immunosuppressive therapy were randomised to once-daily dexamethasone 1 mg (6.5 mg prednisone equivalent) or placebo for 6 months. The primary study parameter was the subscale physical functioning of the 36-item Short Form health survey (SF-36). Secondary parameters included five other patient reported outcome measures, disease activity markers and plasma cytokine profiles. RESULTS A total of 16 patients was randomised to dexamethasone (n = 7) and placebo (n = 9). During follow-up no significant difference for physical functioning was measured (p = 0.18). Dexamethasone treated patients showed a decrease in fatigue score (Checklist Individual Strength) from 106 (baseline) to 88 (3 months; p = 0.03); 86 (6 months; p = 0.05); 79 (9 months; p = 0.04); 90 (12 months; p = 0.03). Placebo treated patients showed no change: 96 (baseline) to 105 (3 months; p = 0.16); 91 (6 months; p = 0.48); 92 (9 months; p = 0.61); 95 (12 months; p = 0.90). During treatment with dexamethasone significant improvements in the SF-36 subscales vitality and pain, and a significant reduction in serum angiotensin-converting enzyme, soluble interleukin 2 receptor levels and serum cytokines and chemokines were measured. CONCLUSIONS Low-dose dexamethasone results in a reduction of the inflammatory profile and has the potential to improve quality of life parameters and fatigue.
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Affiliation(s)
- Roeland Vis
- Dept of Clinical Pharmacy, St Antonius Hospital, Nieuwegein, the Netherlands.
| | | | - Bob Meek
- Dept of Medical Microbiology and Immunology, St Antonius Hospital, Nieuwegein, the Netherlands
| | - Ingrid H E Korenromp
- Interstitial Lung Diseases Centre of Excellence, Dept of Pulmonology, St Antonius Hospital, Nieuwegein, the Netherlands
| | - Jan C Grutters
- Interstitial Lung Diseases Centre of Excellence, Dept of Pulmonology, St Antonius Hospital, Nieuwegein, the Netherlands; Division of Heart & Lungs, University Medical Center Utrecht, Utrecht, the Netherlands
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Judson MA. Developing better drugs for pulmonary sarcoidosis: determining indications for treatment and endpoints to assess therapy based on patient and clinician concerns. F1000Res 2019; 8:F1000 Faculty Rev-2149. [PMID: 31942239 PMCID: PMC6944258 DOI: 10.12688/f1000research.20696.1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/20/2019] [Indexed: 12/19/2022] Open
Abstract
Pulmonary sarcoidosis involves the deposition of granulomas within the lung. These granulomas may affect lung function and lead to pulmonary symptoms, pulmonary dysfunction, functional impairment, and worsening of quality of life. Corticosteroids are generally highly effective in resolving the granulomatous inflammation of sarcoidosis. However, despite the effectiveness of corticosteroids, many corticosteroid-responsive patients continue to experience significant problems because of the development of fibrosis from previously active or active smoldering granulomatous inflammation, inflammatory effects from sarcoidosis unrelated to granuloma deposition in lung tissue (parasarcoidosis syndromes), and the development of significant corticosteroid-related side effects. For these reasons, the decision to treat pulmonary sarcoidosis and endpoints to measure meaningful outcomes may extend beyond considerations of pulmonary granulomatous inflammation alone. In this article, we propose a conceptual framework to describe the mechanisms by which pulmonary sarcoidosis significantly impacts patients. This conceptual framework suggests that indications for the treatment of pulmonary sarcoidosis and endpoints to assess treatment depend on the specific mechanisms that are causing functional or quality-of-life impairment (or both) in patients with pulmonary sarcoidosis. We believe that these concepts are important to clinicians treating pulmonary sarcoidosis and to clinical researchers designing pulmonary sarcoidosis trials.
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Affiliation(s)
- Marc A Judson
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Albany Medical College, Albany, NY, USA
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Judson MA, Preston S, Hu K, Zhang R, Jou S, Modi A, Sukhu I, Ilyas F, Rosoklija G, Yucel R. Quantifying the relationship between symptoms at presentation and the prognosis of sarcoidosis. Respir Med 2019; 152:14-19. [PMID: 31128604 DOI: 10.1016/j.rmed.2019.03.012] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Revised: 03/19/2019] [Accepted: 03/20/2019] [Indexed: 10/27/2022]
Abstract
BACKGROUND Although it is the general consensus that sarcoidosis patients who present with sarcoidosis-related symptoms have a worse outcome than patients whose disease is detected incidentally without symptoms, this premise has not been rigorously examined. METHODS Consecutive patients followed longitudinally at one US university sarcoidosis clinic were questioned concerning the onset and description of sarcoidosis-related symptoms at disease presentation. The patients were classified into those with no sarcoidosis-related symptoms at presentation (NSP group) and those with symptoms at presentation (SP group). The following outcomes were examined in the NSP and SP groups: most recent spirometry, organ involvement, need for sarcoidosis therapy, most recent health related quality of life (HRQOL) as measured by the Sarcoidosis Assessment Tool (SAT), most recent chest imaging Scadding stage results. RESULTS 660 sarcoidosis patients were analyzed, with 175 in the NSP group and 485 in the SP group. Compared to the NSP group, the SP group had a more frequent requirement for any sarcoidosis treatment, corticosteroid treatment, and non-corticosteroid treatment at some time and within the most recent year of follow up (at least 50% more than the NP group with strong statistical differences with p values all 0.01 or less). In addition, the SP group had significantly more organ involvement (p < 0.001) and several worse SAT domains (p < 0.022) than the NP group. There were no differences between the groups in terms of final spirometry or development of Scadding stage 4 chest radiographs. These findings held even after adjusting for age, sex, race, and time between presentation and the most recent follow-up visit using a multivariable logistic regression framework. CONCLUSIONS In our sarcoidosis cohort, compared to the absence of symptoms at presentation, the presence of symptoms was associated with a greater need for treatment, more organ involvement, and worse HRQOL.
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Affiliation(s)
- Marc A Judson
- Division of Pulmonary and Critical Care Medicine, Albany Medical College, Albany, NY, USA.
| | - Sara Preston
- Division of Pulmonary and Critical Care Medicine, Albany Medical College, Albany, NY, USA; St. George's University School of Medicine, Grenada, West Indies
| | - Kurt Hu
- Division of Pulmonary and Critical Care Medicine, Albany Medical College, Albany, NY, USA
| | - Robert Zhang
- Department of Medicine, Albany Medical Center, Albany, NY, USA
| | - Stephanie Jou
- Department of Medicine, Albany Medical Center, Albany, NY, USA
| | - Aakash Modi
- Division of Pulmonary and Critical Care Medicine, Albany Medical College, Albany, NY, USA
| | - Indrawattie Sukhu
- Division of Pulmonary and Critical Care Medicine, Albany Medical College, Albany, NY, USA
| | - Furqan Ilyas
- Division of Pulmonary and Critical Care Medicine, Albany Medical College, Albany, NY, USA
| | | | - Recai Yucel
- Department of Epidemiology and Biostatistics, School of Public Health, State University of New York, Albany, USA
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Can the Sarcoidosis Health Questionnaire predict the long-term outcomes in Japanese sarcoidosis patients? Respir Med 2019; 149:1-8. [DOI: 10.1016/j.rmed.2019.01.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Revised: 10/09/2018] [Accepted: 01/03/2019] [Indexed: 11/18/2022]
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Mañá J, Rubio-Rivas M, Villalba N, Marcoval J, Iriarte A, Molina-Molina M, Llatjos R, García O, Martínez-Yélamos S, Vicens-Zygmunt V, Gámez C, Pujol R, Corbella X. Multidisciplinary approach and long-term follow-up in a series of 640 consecutive patients with sarcoidosis: Cohort study of a 40-year clinical experience at a tertiary referral center in Barcelona, Spain. Medicine (Baltimore) 2017; 96:e7595. [PMID: 28723801 PMCID: PMC5521941 DOI: 10.1097/md.0000000000007595] [Citation(s) in RCA: 62] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2016] [Revised: 06/09/2017] [Accepted: 07/02/2017] [Indexed: 01/12/2023] Open
Abstract
Cohort studies of large series of patients with sarcoidosis over a long period of time are scarce. The aim of this study is to report a 40-year clinical experience of a large series of patients at Bellvitge University Hospital, a tertiary university hospital in Barcelona, Spain. Diagnosis of sarcoidosis required histological confirmation except in certain specific situations. All patients underwent a prospective study protocol. Clinical assessment and follow-up of patients were performed by a multidisciplinary team.From 1976 to 2015, 640 patients were diagnosed with sarcoidosis, 438 of them (68.4%) were female (sex ratio F/M 2:1). The mean age at diagnosis was 43.3 ± 13.8 years (range, 14-86 years), and 613 patients (95.8%) were Caucasian. At diagnosis, 584 patients (91.2%) showed intrathoracic involvement at chest radiograph, and most of the patients had normal pulmonary function. Erythema nodosum (39.8%) and specific cutaneous lesions (20.8%) were the most frequent extrapulmonary manifestations, but there was a wide range of organ involvement. A total of 492 patients (76.8%) had positive histology. Follow-up was carried out in 587 patients (91.7%), over a mean of 112.4 ± 98.3 months (range, 6.4-475 months). Corticosteroid treatment was administered in 255 patients (43.4%), and steroid-sparing agents in 49 patients (7.7%). Outcomes were as follows: 111 patients (18.9%) showed active disease at the time of closing this study, 250 (42.6%) presented spontaneous remission, 61 (10.4%) had remission under treatment, and 165 (28.1%) evolved to chronic sarcoidosis; among them, 115 (19.6%) with mild disease and 50 (8.5%) with moderate to severe organ damage. A multivariate analysis showed that at diagnosis, age more than 40 years, the presence of pulmonary involvement on chest radiograph, splenic involvement, and the need of treatment, was associated with chronic sarcoidosis, whereas Löfgren syndrome and mediastinal lymphadenopathy on chest radiograph were indicators of good outcome.Sarcoidosis is a multisystem disease with protean clinical-radiographic manifestations. Although almost half of patients follow a spontaneous resolution or under treatment, a significant number of them may have several degrees of organ damage. This study emphasizes the value of a multidisciplinary approach and long-term follow-up by specialized teams in sarcoidosis.
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Affiliation(s)
- Juan Mañá
- Department of Internal Medicine
- University of Barcelona
- Bellvitge University Hospital, Bellvitge Biomedical Research Institute-IDIBELL, L’Hospitalet de Llobregat, Barcelona, Spain
| | - Manuel Rubio-Rivas
- Department of Internal Medicine
- Bellvitge University Hospital, Bellvitge Biomedical Research Institute-IDIBELL, L’Hospitalet de Llobregat, Barcelona, Spain
| | - Nadia Villalba
- Department of Internal Medicine
- Bellvitge University Hospital, Bellvitge Biomedical Research Institute-IDIBELL, L’Hospitalet de Llobregat, Barcelona, Spain
| | - Joaquim Marcoval
- Department of Dermatology
- University of Barcelona
- Bellvitge University Hospital, Bellvitge Biomedical Research Institute-IDIBELL, L’Hospitalet de Llobregat, Barcelona, Spain
| | - Adriana Iriarte
- Department of Internal Medicine
- Bellvitge University Hospital, Bellvitge Biomedical Research Institute-IDIBELL, L’Hospitalet de Llobregat, Barcelona, Spain
| | - María Molina-Molina
- Department of Pulmonary
- University of Barcelona
- Bellvitge University Hospital, Bellvitge Biomedical Research Institute-IDIBELL, L’Hospitalet de Llobregat, Barcelona, Spain
| | - Roger Llatjos
- Department of Pathology
- University of Barcelona
- Bellvitge University Hospital, Bellvitge Biomedical Research Institute-IDIBELL, L’Hospitalet de Llobregat, Barcelona, Spain
| | - Olga García
- Department of Ophthalmology
- University of Barcelona
- Bellvitge University Hospital, Bellvitge Biomedical Research Institute-IDIBELL, L’Hospitalet de Llobregat, Barcelona, Spain
| | - Sergio Martínez-Yélamos
- Department of Neurology
- University of Barcelona
- Bellvitge University Hospital, Bellvitge Biomedical Research Institute-IDIBELL, L’Hospitalet de Llobregat, Barcelona, Spain
| | - Vanessa Vicens-Zygmunt
- Department of Pulmonary
- Bellvitge University Hospital, Bellvitge Biomedical Research Institute-IDIBELL, L’Hospitalet de Llobregat, Barcelona, Spain
| | - Cristina Gámez
- Department of PET Unit-Institut de Diagnòstic per la Imatge
- Faculty of Medicine and Health Sciences, Universitat Internacional de Catalunya
- Bellvitge University Hospital, Bellvitge Biomedical Research Institute-IDIBELL, L’Hospitalet de Llobregat, Barcelona, Spain
| | - Ramón Pujol
- Department of Internal Medicine
- University of Barcelona
- Bellvitge University Hospital, Bellvitge Biomedical Research Institute-IDIBELL, L’Hospitalet de Llobregat, Barcelona, Spain
| | - Xavier Corbella
- Department of Internal Medicine
- Faculty of Medicine and Health Sciences, Universitat Internacional de Catalunya
- Bellvitge University Hospital, Bellvitge Biomedical Research Institute-IDIBELL, L’Hospitalet de Llobregat, Barcelona, Spain
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Baughman RP, Judson MA, Wells A. The indications for the treatment of sarcoidosis: Wells Law. SARCOIDOSIS, VASCULITIS, AND DIFFUSE LUNG DISEASES : OFFICIAL JOURNAL OF WASOG 2017; 34:280-282. [PMID: 32476859 PMCID: PMC7170078 DOI: 10.36141/svdld.v34i4.6957] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Accepted: 12/06/2017] [Indexed: 02/05/2023]
Affiliation(s)
- Robert P. Baughman
- Department of Medicine, University of Cincinnati Medical Center, Cincinnati, OH USA
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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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Abstract
INTRODUCTION Numerous biomarkers have been evaluated for the diagnosis, assessment of disease activity, prognosis, and response to treatment in sarcoidosis. In this report, we discuss the clinical and research utility of several biomarkers used to evaluate sarcoidosis. Areas covered: The sarcoidosis biomarkers discussed include serologic tests, imaging studies, identification of inflammatory cells and genetic analyses. Literature was obtained from medical databases including PubMed and Web of Science. Expert commentary: Most of the biomarkers examined in sarcoidosis are not adequately specific or sensitive to be used in isolation to make clinical decisions. However, several sarcoidosis biomarkers have an important role in the clinical management of sarcoidosis when they are coupled with clinical data including the results of other biomarkers.
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Affiliation(s)
- Amit Chopra
- a Division of Pulmonary and Critical Care Medicine , Albany Medical College , Albany , NY , USA
| | - Alexandros Kalkanis
- b Department of Medicine , Division of Pulmonary and Critical Care Medicine , Athens , Greece
| | - Marc A Judson
- a Division of Pulmonary and Critical Care Medicine , Albany Medical College , Albany , NY , USA
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Jeny F, Bouvry D, Freynet O, Soussan M, Brauner M, Planes C, Nunes H, Valeyre D. Management of sarcoidosis in clinical practice. Eur Respir Rev 2016; 25:141-50. [DOI: 10.1183/16000617.0013-2016] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2016] [Accepted: 04/07/2016] [Indexed: 11/05/2022] Open
Abstract
Sarcoidosis is a systemic disease of unknown cause with very diverse presentation, outcome, severity and need for treatments. While some presentations may be very typical, for many patients, the presentation is nonspecific, with shared associations with other diseases at times being by far more frequent or misleading, which can be a cause of significant delay and often several consultations before a diagnosis of sarcoidosis can be confirmed. This is particularly the case when pulmonary manifestations are in the forefront. The diagnosis relies on three well-known criteria. In clinical practice, these criteria are not easily implemented, particularly by physicians without expertise in sarcoidosis, which can lead to a risk of either under- or over-diagnosis. Qualifying the presentation according to sarcoidosis diagnosis is essential. However, it is often not easy to classify the presentation as typical versus compatible or compatible versus inconsistent. Further investigations are needed before any other hypothesis is to be considered. It is important to detect events and to determine whether or not they are indicative of a flare of sarcoidosis. Eventually, treatment needs to be related to the correct indications. The evaluation of the efficacy and safety of treatments is crucial. To address such issues, we present five emblematic cases that illustrate this.
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