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Mittal S, Pogorzelski K, Huxel C, Siva C, Rao D. An Atypical Case of Extrapulmonary Sarcoidosis with Severe Hypercalcemia as Initial Presentation, Successfully Treated with Glucocorticoids. Clin Pract 2024; 14:1264-1269. [PMID: 39051296 PMCID: PMC11270185 DOI: 10.3390/clinpract14040102] [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: 03/19/2024] [Revised: 05/05/2024] [Accepted: 06/21/2024] [Indexed: 07/27/2024] Open
Abstract
BACKGROUND Sarcoidosis is a multisystemic disease that is histologically characterized by non-caseating granulomas in one or more organs. Although hypercalcemia is commonly seen in sarcoidosis, clinically significant hypercalcemia as the initial presentation of sarcoidosis is exceedingly rare. Long-standing hypercalcemia can lead to several complications and needs to be adequately managed to prevent irreversible damage. Currently, there are no standard treatment guidelines for sarcoidosis-induced hypercalcemia, although glucocorticoids have often been used as first-line therapy. CASE REPORT We describe a 55-year-old male patient who presented with dull right upper quadrant abdominal pain and a 30-pound weight loss over one month. He was found to have severe hypercalcemia, which was treated with intravenous (IV) normal saline and intramuscular calcitonin. Imaging studies revealed hypodense lesions throughout the bilateral hepatic lobes, spleen, and bilateral kidneys, with no pathologic mediastinal, hilar, supraclavicular, or axillary lymphadenopathy or pulmonary parenchymal disease. A splenic biopsy confirmed extrapulmonary sarcoidosis. After initial discharge, the patient was re-admitted weeks later for severe hypercalcemia, which was successfully treated with the initiation of prednisone. CONCLUSIONS In this report, we present an atypical case of isolated extrapulmonary sarcoidosis with severe hypercalcemia as the initial presentation, successfully treated with steroids.
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Affiliation(s)
- Sushmita Mittal
- Department of Medicine, University of Missouri, Columbia, MO 65212, USA;
| | | | - Christopher Huxel
- Department of Medicine, University of Missouri, Columbia, MO 65212, USA;
| | - Chokkalingam Siva
- Department of Rheumatology, University of Missouri, Columbia, MO 65212, USA
| | - Deepthi Rao
- Department of Pathology, University of Missouri, Columbia, MO 65212, USA;
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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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Samad A, Wobma H, Casey A. Innovations in the care of childhood interstitial lung disease associated with connective tissue disease and immune-mediated disorders. Pediatr Pulmonol 2024. [PMID: 38837875 DOI: 10.1002/ppul.27068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 04/05/2024] [Accepted: 05/07/2024] [Indexed: 06/07/2024]
Abstract
Childhood interstitial lung disease (chILD) associated with connective tissue and immune mediated disorders is the second most common chILD diagnostic category. As knowledge of the molecular and genetic underpinnings of these rare disorders advances, the recognized clinical spectrum of associated pulmonary manifestations continues to expand. Pulmonary complications of these diseases, including ILD, confer increased risk for morbidity and mortality and contribute to increased complexity for providers tasked with managing the multiple organ systems that can be impacted in these systemic disorders. While pulmonologists play an important role in diagnosis and management of these conditions, thankfully they do not have to work alone. In collaboration with a multidisciplinary team of subspecialists, the pulmonary and other systemic manifestations of these conditions can be managed effectively together. The goal of this review is to familiarize the reader with the classic patterns of chILD and other pulmonary complications associated with primary immune-mediated disorders (monogenic inborn errors of immunity) and acquired systemic autoimmune and autoinflammatory diseases. In addition, this review will highlight current, emerging, and innovative therapeutic strategies and will underscore the important role of multidisciplinary management to improving outcomes for these patients.
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Affiliation(s)
- Aaida Samad
- Division of Pulmonary Medicine, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Holly Wobma
- Division of Immunology, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Alicia Casey
- Division of Pulmonary Medicine, Boston Children's Hospital, Boston, Massachusetts, USA
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Gwadera Ł, Białas AJ, Kumor-Kisielewska A, Miłkowska-Dymanowska J, Majewski S, Piotrowski WJ. Calcium, Phosphate, and Vitamin D Status in Patients with Sarcoidosis-Associations with Disease Activity and Symptoms. J Clin Med 2023; 12:4745. [PMID: 37510860 PMCID: PMC10381487 DOI: 10.3390/jcm12144745] [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: 05/21/2023] [Revised: 07/13/2023] [Accepted: 07/15/2023] [Indexed: 07/30/2023] Open
Abstract
Sarcoidosis is a systemic granulomatous disease with a variety of presentations. One of the known symptoms are altered vitamin D metabolism and hypercalcemia. In our study, we aimed to assess associations between disease activity, inflammatory parameters, and vitamin D and calcium status. The secondary aim was to find any dependencies between calcium and vitamin D metabolism and fatigue and quality of life in patients with sarcoidosis. We enrolled 58 patients with sarcoidosis (47 classified as active disease, 11 classified as non-active) and compared them with 25 healthy volunteers. Calcium concentration was significantly higher in the study group than in healthy controls. It correlated with some inflammatory markers but not with vitamin D status. Not calcium nor vitamin D, but phosphate concentration correlated with life quality was assessed with the use of the Sarcoidosis Health Questionnaire. An association between phosphate concentration and fatigue was also noted, but it did not reach statistical significance. Calcium concentration was higher in patients with sarcoidosis, but it was not an indicator of the disease activity, while phosphate concentration was significantly lower in patients with active sarcoidosis.
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Affiliation(s)
- Łukasz Gwadera
- Department of Pneumology, Medical University of Lodz, 90-153 Lodz, Poland
| | - Adam J Białas
- Department of Pneumology, Medical University of Lodz, 90-153 Lodz, Poland
| | | | | | - Sebastian Majewski
- Department of Pneumology, Medical University of Lodz, 90-153 Lodz, Poland
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Drake WP, Hsia C, Samavati L, Yu M, Cardenas J, Gianella FG, Boscardin J, Koth LL. Risk Indicators of Sarcoidosis Evolution-Unified Protocol (RISE-UP): protocol for a multi-centre, longitudinal, observational study to identify clinical features that are predictive of sarcoidosis progression. BMJ Open 2023; 13:e071607. [PMID: 37012011 PMCID: PMC10083794 DOI: 10.1136/bmjopen-2023-071607] [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: 01/03/2023] [Accepted: 03/20/2023] [Indexed: 04/04/2023] Open
Abstract
INTRODUCTION Sarcoidosis is a pulmonary and systemic granulomatous disease with a wide range of potential outcomes, from spontaneous resolution to end-stage organ damage and death. Currently, clinicians have no easy-to-use risk stratification tools for important clinical outcomes in sarcoidosis, such as progressive lung disease. This study will address two clinical practice needs: (1) development of a risk calculator that provides an estimate of the likelihood of pulmonary progression in sarcoidosis patients during the follow-up period and (2) determine the optimal interval for serial clinical monitoring (eg, 6, 12, 18 months) using these risk prediction tools. METHODS AND ANALYSIS The Risk Indicators of Sarcoidosis Evolution-Unified Protocol study is a National Institutes of Health-sponsored, longitudinal observational study of adults with pulmonary sarcoidosis who will be enrolled at five US tertiary care centres. Participants will be evaluated at approximately 6-month intervals for up to 60 months with collection of lung function, blood samples and clinical data. The target sample size is 557 and the primary objective is to determine which clinical features measured during a routine clinic visit carry the most prognostic information for predicting clinical progression of pulmonary sarcoidosis over the follow-up period. The primary outcome measure will be quantified by a clinically meaningful change in forced vital capacity, forced expiratory volume in 1 s or diffusing capacity of the lung for carbon monoxide. The secondary objective is to determine if blood biomarkers measured during a routine clinic visit can improve the risk assessment modelling for progression of pulmonary sarcoidosis over the follow-up period. ETHICS AND DISSEMINATION The study protocol has been approved by the Institutional Review Boards at each centre and the reliance Institutional Review Board overseeing the study (WCG, Protocol #20222400). Participants will provide informed consent prior to enrolment. Results will be disseminated via publication in a relevant peer-reviewed journal. TRIAL REGISTRATION NUMBER NCT05567133.
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Affiliation(s)
- Wonder P Drake
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Connie Hsia
- Department of Internal Medicine, UT Southwestern Medical School, Dallas, Texas, USA
| | - Lobelia Samavati
- Department of Medicine, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Michelle Yu
- Department of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Jessica Cardenas
- Department of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Fabiola G Gianella
- Department of Internal Medicine, UT Southwestern Medical School, Dallas, Texas, USA
| | - John Boscardin
- Department of Medicine and Epidemiology & Biostatistics, University of California San Francisco, San Francisco, California, USA
| | - Laura L Koth
- Department of Medicine and Epidemiology & Biostatistics, University of California San Francisco, San Francisco, California, USA
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Summary for Clinicians: Clinical Practice Guideline for the Diagnosis and Detection of Sarcoidosis. Ann Am Thorac Soc 2021; 17:1510-1515. [PMID: 32970953 DOI: 10.1513/annalsats.202007-874cme] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Werner J, Rivera N, Grunewald J, Eklund A, Iseda T, Darlington P, Kullberg S. HLA-DRB1 alleles associate with hypercalcemia in sarcoidosis. Respir Med 2021; 187:106537. [PMID: 34325227 DOI: 10.1016/j.rmed.2021.106537] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 06/19/2021] [Accepted: 07/03/2021] [Indexed: 01/01/2023]
Abstract
BACKGROUND The mechanisms behind and which patients are at risk of developing sarcoidosis associated hypercalcemia (SAHC) have not been addressed. Different human leukocyte antigen (HLA) alleles associate with disease phenotypes in sarcoidosis. Insights into associations between HLA alleles, clinical phenotype and calcium levels may provide clues to mechanisms behind SAHC and help monitoring patients at risk for SAHC. AIMS AND OBJECTIVES To identify any HLA-association with SAHC, and to phenotypically characterize this patient group. METHODS 66 patients with SAHC (s-Ca2+>1.33 mmol/L) and 150 normocalcemic patients as controls were identified in a cohort of sarcoidosis patients. Data on HLA-DRB1 alleles, sex, angiotensin-converting enzyme (ACE), creatinine, extrapulmonary manifestations (EPM), age at sarcoidosis diagnosis, and how long after diagnosis SAHC emerged, were retrieved. RESULTS HLA-DRB1*04 was more common in patients with SAHC and the proportion of patients with HLA-DRB1*04 increased the more pronounced hypercalcemia. In patients with s-Ca2+>1.4 mmol/L, 20 out of 30 carried the HLA-DRB1*04 allele (67%, p < 0.01). Patients with SAHC more often disclosed renal insufficiency, elevated ACE, EPM, and a non-resolving disease than controls. The mean duration between sarcoidosis diagnosis and detection of SAHC was 1.39 years. CONCLUSIONS SAHC is associated with a more severe disease phenotype, particularly patients carrying the HLA-DRB1*04 allele are at higher risk for SAHC. HLA-assessment in the clinic can be a way to identify these patients. The results provide a basis for future studies on the connection between HLA-DRB1*04 and SAHC mechanisms.
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Affiliation(s)
- Joanna Werner
- Department of Respiratory Medicine, Theme Inflammation and Infection, Karolinska University Hospital, 171 76, Stockholm, Sweden; Department of Medicine Solna, Respiratory Medicine Division, Karolinska Institutet, 171 77, Stockholm, Sweden.
| | - Natalia Rivera
- Department of Medicine Solna, Respiratory Medicine Division, Karolinska Institutet, 171 77, Stockholm, Sweden.
| | - Johan Grunewald
- Department of Respiratory Medicine, Theme Inflammation and Infection, Karolinska University Hospital, 171 76, Stockholm, Sweden; Department of Medicine Solna, Respiratory Medicine Division, Karolinska Institutet, 171 77, Stockholm, Sweden.
| | - Anders Eklund
- Department of Medicine Solna, Respiratory Medicine Division, Karolinska Institutet, 171 77, Stockholm, Sweden.
| | - Tomoko Iseda
- Department of Medicine Solna, Respiratory Medicine Division, Karolinska Institutet, 171 77, Stockholm, Sweden.
| | - Pernilla Darlington
- Department of Internal Medicine, Sjukhusbacken 10, Södersjukhuset, 118 83, Stockholm, Sweden; Department of Clinical Science and Education, Södersjukhuset and Karolinska Institutet, 171 77, Stockholm, Sweden.
| | - Susanna Kullberg
- Department of Respiratory Medicine, Theme Inflammation and Infection, Karolinska University Hospital, 171 76, Stockholm, Sweden; Department of Medicine Solna, Respiratory Medicine Division, Karolinska Institutet, 171 77, Stockholm, Sweden.
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8
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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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Crouser ED, Maier LA, Wilson KC, Bonham CA, Morgenthau AS, Patterson KC, Abston E, Bernstein RC, Blankstein R, Chen ES, Culver DA, Drake W, Drent M, Gerke AK, Ghobrial M, Govender P, Hamzeh N, James WE, Judson MA, Kellermeyer L, Knight S, Koth LL, Poletti V, Raman SV, Tukey MH, Westney GE. Diagnosis and Detection of Sarcoidosis. An Official American Thoracic Society Clinical Practice Guideline. Am J Respir Crit Care Med 2020; 201:e26-e51. [PMID: 32293205 PMCID: PMC7159433 DOI: 10.1164/rccm.202002-0251st] [Citation(s) in RCA: 455] [Impact Index Per Article: 113.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Background: The diagnosis of sarcoidosis is not standardized but is based on three major criteria: a compatible clinical presentation, finding nonnecrotizing granulomatous inflammation in one or more tissue samples, and the exclusion of alternative causes of granulomatous disease. There are no universally accepted measures to determine if each diagnostic criterion has been satisfied; therefore, the diagnosis of sarcoidosis is never fully secure. Methods: Systematic reviews and, when appropriate, meta-analyses were performed to summarize the best available evidence. The evidence was appraised using the Grading of Recommendations, Assessment, Development, and Evaluation approach and then discussed by a multidisciplinary panel. Recommendations for or against various diagnostic tests were formulated and graded after the expert panel weighed desirable and undesirable consequences, certainty of estimates, feasibility, and acceptability. Results: The clinical presentation, histopathology, and exclusion of alternative diagnoses were summarized. On the basis of the available evidence, the expert committee made 1 strong recommendation for baseline serum calcium testing, 13 conditional recommendations, and 1 best practice statement. All evidence was very low quality. Conclusions: The panel used systematic reviews of the evidence to inform clinical recommendations in favor of or against various diagnostic tests in patients with suspected or known sarcoidosis. The evidence and recommendations should be revisited as new evidence becomes available.
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Gwadera Ł, Białas AJ, Iwański MA, Górski P, Piotrowski WJ. Sarcoidosis and calcium homeostasis disturbances-Do we know where we stand? Chron Respir Dis 2020; 16:1479973119878713. [PMID: 31718265 PMCID: PMC6854763 DOI: 10.1177/1479973119878713] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
The majority of cases involving hypercalcemia in the setting of sarcoidosis are explained by the overproduction of calcitriol by activated macrophages. Vitamin D takes part in the regulation of granuloma formation. However, using vitamin D metabolites to assess the activity of the disease is still problematic, and its usefulness is disputable. In some cases, though, a calcium metabolism disorder could be a valuable tool (i.e. as a marker of extrathoracic sarcoidosis). Although sarcoidosis does not cause a decrease in bone mineral density, increased incidence of vertebral deformities is noted. Despite increasing knowledge about calcium homeostasis disorders in patients with sarcoidosis, there is still a need for clear guidelines regarding calcium and vitamin D supplementation in these patients.
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Affiliation(s)
- Łukasz Gwadera
- Department of Pneumology and Allergy, Chair of Internal Medicine, Medical University of Lodz, Poland
| | - Adam Jerzy Białas
- Department of Pneumology and Allergy, Chair of Internal Medicine, Medical University of Lodz, Poland
| | | | - Paweł Górski
- Department of Pneumology and Allergy, Chair of Internal Medicine, Medical University of Lodz, Poland
| | - Wojciech Jerzy Piotrowski
- Department of Pneumology and Allergy, Chair of Internal Medicine, Medical University of Lodz, Poland
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Cameli P, Gonnelli S, Bargagli E, d’Alessandro M, Bergantini L, Favetta V, Tomai Pitinca M, Lisi E, Refini R, Pieroni M, Sestini P, Caffarelli C. The Role of Urinary Calcium and Chitotriosidase in a Cohort of Chronic Sarcoidosis Patients. Respiration 2020; 99:207-212. [DOI: 10.1159/000505653] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Accepted: 12/29/2019] [Indexed: 11/19/2022] Open
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Gialafos E, Kolilekas L, Manali E, Katsanos S, Steiropoulos P, Tsougos E, Stratakos G, Gaga M, Koulouris N, Papiris S, Ilias I. Association of the calcitriol to calcifediol ratio with cardiac involvement in newly diagnosed sarcoidosis. SARCOIDOSIS, VASCULITIS, AND DIFFUSE LUNG DISEASES : OFFICIAL JOURNAL OF WASOG 2020; 37:e2020008. [PMID: 33264381 PMCID: PMC7690060 DOI: 10.36141/svdld.v37i3.9939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 09/04/2020] [Indexed: 11/02/2022]
Affiliation(s)
- Elias Gialafos
- 1 Respiratory Medicine Department, Athens Chest Hospital ‘Sotiria’ Medical School, National and Kapodistrian University of Athens, Greece, 6 Department of Cardiology, Heart Failure and Preventive Cardiology Section, Ygeia Hospital, Athens, Greece
| | - Lykourgos Kolilekas
- 7 Respiratory Medicine Department, Athens Chest Hospital ‘Sotiria’, Athens, Greece
| | - Effrosyni Manali
- 2 Pulmonary Medicine Department, General University Hospital ‘Attikon’, Medical School, National and Kapodistrian University of Athens, Greece
| | - Spyros Katsanos
- 2 Department of Cardiology, General University Hospital “Attikon”, Medical School, National and Kapodistrian University of Athens, Greece
| | - Paschalis Steiropoulos
- Department of Respiratory Medicine, University General Hospital, Medical School, Democritus University of Thrace, Greece
| | - Elias Tsougos
- 6 Department of Cardiology, Heart Failure and Preventive Cardiology Section, Ygeia Hospital, Athens, Greece
| | - Grigorios Stratakos
- 1 Respiratory Medicine Department, Athens Chest Hospital ‘Sotiria’ Medical School, National and Kapodistrian University of Athens, Greece
| | - Mina Gaga
- 7 Respiratory Medicine Department, Athens Chest Hospital ‘Sotiria’, Athens, Greece
| | - Nikos Koulouris
- 1 Respiratory Medicine Department, Athens Chest Hospital ‘Sotiria’ Medical School, National and Kapodistrian University of Athens, Greece
| | - Spyros Papiris
- 2 Pulmonary Medicine Department, General University Hospital ‘Attikon’, Medical School, National and Kapodistrian University of Athens, Greece
| | - Ioannis Ilias
- Department of Diabetes, Endocrinology and Metabolism, Elena Venizelou Hospital, Athens, Greece
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13
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Shirvani A, Palermo NE, Holick MF. Man of Steel Syndrome: Silicone and Mineral Oil Injections With Associated Hypercalcemia, Hypophosphatemia, and Proximal Muscle Weakness. JBMR Plus 2019; 3:e10208. [PMID: 31687644 PMCID: PMC6820462 DOI: 10.1002/jbm4.10208] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Revised: 05/02/2019] [Accepted: 05/25/2019] [Indexed: 11/10/2022] Open
Abstract
Silicone/mineral oil‐induced granulomas have been described as an inflammatory granulomatous response when silicone/mineral oil is injected for cosmetic purposes. These sclerosing granulomas can lead to hypercalcemia. Here we present a 33‐year‐old man with hypercalcemia, hypophosphatemia, progressively worsening fatigue, severe proximal muscle weakness, and depression. He had an athletic build with increased muscle bulk and several areas of indurated, nontender, firm, well‐circumscribed lesions in the subcutaneous tissue of his anterior pectoralis, triceps, and biceps bilaterally because of injecting himself with silicone/mineral oil‐based product into his muscles. Sclerosing granulomas were diagnosed on the MRI. He had extremely low or undetectable serum levels of 25‐hydroxyvitamin D [25(OH)D], and persistently elevated serum levels of 1,25‐dihydroxyvitamin D [1,25(OH)2D] and calcium. He developed hypophosphatemia associated with elevated levels of fibroblast growth factor 23 (FGF‐23) and severe proximal muscle weakness. Treatment with systemic steroids, furosemide, calcitonin, ketoconazole, and denosumab resulted in a significant decrease in his serum calcium, but with minimal impact on his hypophosphatemia and fatigue.Correcting his severe vitamin D deficiency with small doses of vitamin D and raising his blood level of 25(OH)D from undetectable to 10 ng/mL without significantly affecting his serum calcium or phosphate was effective in reversing his severe proximal muscle weakness, permitting him to lift his head and to be free of his wheelchair. Although measurement of the 1,25(OH)2D level is not mandatory in all cases of hypercalcemia, it is indicated in a patient who has low serum PTH levels. Clinicians need to be aware that vitamin D deficiency can cause severe proximal muscle weakness such that the patient is unable to lift his head from his chest or ambulate. This may lead to a psychiatric disorder misdiagnosis. © 2019 The Authors. JBMR Plus is published by Wiley Periodicals, Inc. on behalf of the American Society for Bone and Mineral Research.
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Affiliation(s)
- Arash Shirvani
- Section of Endocrinology, Diabetes & Nutrition, Department of Medicine, Vitamin D, Skin, and Bone Research Laboratory Boston University School of Medicine (BUSM) Boston MA USA
| | - Nadine E Palermo
- Division of Endocrinology Diabetes and Hypertension, Brigham and Women's Hospital, Harvard Medical School Boston MA USA
| | - Michael F Holick
- Section of Endocrinology, Diabetes & Nutrition, Department of Medicine, Vitamin D, Skin, and Bone Research Laboratory Boston University School of Medicine (BUSM) Boston MA USA
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Bettuzzi T, Ram-Wolff C, Hau E, de Masson A, Vignon-Pennamen MD, Beylot-Barry M, Cormier C, Bagot M. Severe hypercalcemia complicating granulomatous slack skin disease: an exceptional case. J Eur Acad Dermatol Venereol 2019; 33:e354-e356. [PMID: 31026372 DOI: 10.1111/jdv.15646] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- T Bettuzzi
- Dermatology Department, Hospital St Louis, Paris 7 University, 1 Avenue Claude Vellefaux, 75010, Paris, France
| | - C Ram-Wolff
- Dermatology Department, Hospital St Louis, Paris 7 University, 1 Avenue Claude Vellefaux, 75010, Paris, France
| | - E Hau
- Dermatology Department, Hospital St Louis, Paris 7 University, 1 Avenue Claude Vellefaux, 75010, Paris, France
| | - A de Masson
- Dermatology Department, Hospital St Louis, Paris 7 University, 1 Avenue Claude Vellefaux, 75010, Paris, France
| | - M D Vignon-Pennamen
- Pathology Department, Hospital St Louis, Paris 7 University, 1 Avenue Claude Vellefaux, 75010, Paris, France
| | - M Beylot-Barry
- Dermatology Department, CHU Bordeaux, Bordeaux University, Hospital Saint-André, 1 rue Jean Burguet, 33075, Bordeaux, France
| | - C Cormier
- Rhumatology Department, Hospital Cochin, Paris 5 University, 27 rue du faubourg saint Jacques, 75014, Paris, France
| | - M Bagot
- Dermatology Department, Hospital St Louis, Paris 7 University, 1 Avenue Claude Vellefaux, 75010, Paris, France
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15
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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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Rohmer J, Hadjadj J, Bouzerara A, Salah S, Paule R, Groh M, Blanche P, Mouthon L, Monnet D, Le Jeunne C, Guibourdenche J, Brézin A, Terrier B. Serum 1,25(OH)2 Vitamin D and 25(OH) Vitamin D Ratio for the Diagnosis of Sarcoidosis-Related Uveitis. Ocul Immunol Inflamm 2018; 28:341-347. [DOI: 10.1080/09273948.2018.1537399] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Affiliation(s)
- Julien Rohmer
- Department of Internal Medicine, Cochin Hospital, Paris, France
| | - Jérôme Hadjadj
- Department of Internal Medicine, Cochin Hospital, Paris, France
| | | | - Sawsen Salah
- Department of Ophthalmology, Cochin Hospital, Paris, France
| | - Romain Paule
- Department of Internal Medicine, Cochin Hospital, Paris, France
| | - Matthieu Groh
- Department of Internal Medicine, Cochin Hospital, Paris, France
- Department of Internal Medicine, Foch Hospital, Suresnes, France
| | | | - Luc Mouthon
- Department of Internal Medicine, Cochin Hospital, Paris, France
- 5 INSERM 1016, Centre de référence pour les Maladies Auto-immunes Rares, Université Paris Descartes, Paris, France
| | | | | | | | - Antoine Brézin
- Department of Ophthalmology, Cochin Hospital, Paris, France
| | - Benjamin Terrier
- Department of Internal Medicine, Cochin Hospital, Paris, France
- 5 INSERM 1016, Centre de référence pour les Maladies Auto-immunes Rares, Université Paris Descartes, Paris, France
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Whole-exome sequencing identifies rare genetic variations in German families with pulmonary sarcoidosis. Hum Genet 2018; 137:705-716. [DOI: 10.1007/s00439-018-1915-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Accepted: 07/20/2018] [Indexed: 12/12/2022]
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18
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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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Abstract
PURPOSE OF REVIEW Vitamin D supplementation is widespread used in the general population. In sarcoidosis, up to 50% of patients, especially postmenopausal women and those taking corticosteroids, show evidence of increased bone fragility. The purpose of this review is to provide an evidence-based rationale on how to treat sarcoidosis patients with bone health issues. RECENT FINDINGS Evidence from observational studies show that decreased 25-hydroxy vitamin D is common in sarcoidosis. However, the great majority of sarcoidosis patents have normal or often elevated levels of 1,25-dihydroxy vitamin D (calcitriol), a marker associated with disease activity. High calcitriol levels may often be associated with hypercalcemia and hypercalcuria. The few interventional randomized controlled studies in the field, suggest that vitamin D supplementation may not be well tolerated because of hypercalcemia, moreover without substantial benefit on bone health and risk for fractures in these patients. SUMMARY Vitamin D supplementation may be withheld in sarcoidosis patients with bone fragility, unless calcitriol levels are below normal limits. A treating scheme is proposed.
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Saidenberg-Kermanac’h N, Valeyre D, Boissier MC. Vitamin D supplementation in patients treated for sarcoidosis: Controversy or consensus? Joint Bone Spine 2017; 84:521-523. [DOI: 10.1016/j.jbspin.2017.03.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/05/2017] [Indexed: 11/24/2022]
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Abstract
Vitamin D testing is part of laboratory practice since more than 30 years but has become a routine parameter only recently, due to a highly increasing amount of research in the field resulting in new clinical applications. Vitamin D actually represents a family of molecules of which 25OH Vitamin D and 1,25(OH)2 Vitamin D, under their D3 and D2 forms, are the most important to date. Physical detection methods and immunoassays exist for both molecules and are being reviewed and discussed. New developments in the measurement of C3-epi-25OH Vitamin D, 24,25(OH)2 Vitamin D, and free/bioavailable 25OH Vitamin D are also presented. The future of Vitamin D testing is considered based on the evolution of laboratories and based on the scientific research that is currently performed.
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Affiliation(s)
- N Heureux
- DIAsource Immunoassays, Louvain-la-Neuve, Belgium.
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Martinez-Bravo MJ, Wahlund CJE, Qazi KR, Moulder R, Lukic A, Rådmark O, Lahesmaa R, Grunewald J, Eklund A, Gabrielsson S. Pulmonary sarcoidosis is associated with exosomal vitamin D-binding protein and inflammatory molecules. J Allergy Clin Immunol 2016; 139:1186-1194. [PMID: 27566455 DOI: 10.1016/j.jaci.2016.05.051] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2016] [Revised: 05/18/2016] [Accepted: 05/31/2016] [Indexed: 12/11/2022]
Abstract
BACKGROUND Sarcoidosis is an inflammatory granulomatous disorder characterized by accumulation of TH1-type CD4+ T cells and immune effector cells within affected organs, most frequently the lungs. Exosomes are extracellular vesicles conveying intercellular communication with possible diagnostic and therapeutic applications. OBJECTIVES We aimed to provide an understanding of the proinflammatory role of bronchoalveolar lavage fluid (BALF) exosomes in patients with sarcoidosis and to find candidates for disease biomarkers. METHODS We performed a mass spectrometric proteomics characterization of BALF exosomes from 15 patients with sarcoidosis and 5 healthy control subjects and verified the most interesting results with flow cytometry, ELISA, and Western blot analyses in an additional 39 patients and 22 control subjects. RESULTS More than 690 proteins were identified in the BALF exosomes, several of which displayed significant upregulation in patients, including inflammation-associated proteins, such as leukotriene A4 hydrolase. Most of the complement-activating factors were upregulated, whereas the complement regulator CD55 was seen less in patients compared with healthy control subjects. In addition, for the first time, we detected vitamin D-binding protein in BALF exosomes, which was more abundant in patients. To evaluate exosome-associated vitamin D-binding protein as a biomarker for sarcoidosis, we investigated plasma exosomes from 23 patients and 11 healthy control subjects and found significantly higher expression in patients. CONCLUSION Together, these data contribute to understanding the role of exosomes in lung disease and provide suggestions for highly warranted sarcoidosis biomarkers. Furthermore, the validation of an exosome-associated biomarker in the blood of patients provides novel, and less invasive, opportunities for disease diagnosis.
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Affiliation(s)
- Maria-Jose Martinez-Bravo
- Unit for Immunology and Allergy, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - Casper J E Wahlund
- Unit for Immunology and Allergy, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - Khaleda Rahman Qazi
- Unit for Immunology and Allergy, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - Robert Moulder
- Turku Centre for Biotechnology, University of Turku, Turku, Finland
| | - Ana Lukic
- Department of Medical Biochemistry and Biophysics, Division of Physiological Chemistry II, Karolinska Institutet, University Hospital, Solna, Stockholm, Sweden
| | - Olof Rådmark
- Department of Medical Biochemistry and Biophysics, Division of Physiological Chemistry II, Karolinska Institutet, University Hospital, Solna, Stockholm, Sweden
| | - Riitta Lahesmaa
- Turku Centre for Biotechnology, University of Turku, Turku, Finland
| | - Johan Grunewald
- Respiratory Unit, Karolinska Institutet and University Hospital, Stockholm, Sweden
| | - Anders Eklund
- Respiratory Unit, Karolinska Institutet and University Hospital, Stockholm, Sweden
| | - Susanne Gabrielsson
- Unit for Immunology and Allergy, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden.
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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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Abstract
PURPOSE OF REVIEW To describe the methods for derivation of clinical phenotypes in general and how they should be applied in sarcoidosis, taking into account the dimensions of the disease. The results from the small number of studies in this area are summarized. RECENT FINDINGS Clinical phenotypes are determined by diverse ways. In sarcoidosis, some studies defined clinical phenotypes based on severity of disease and outcome after treatment of variable duration. A second approach to characterize clinical phenotypes is by using analytic or multivariate techniques. This approach considers several domains of disease and does not make assumptions a priori, with the hypothesis being developed after the results. A small study used factorial analysis for this purpose. Some well defined clinical phenotypes are described and future directions for research are given. SUMMARY Clinical phenotypes, by examining relationships between several domains in sarcoidosis, are likely to better delineate the underlying processes and pathways. Larger studies with appropriate methods should be performed to better delineate clinical phenotypes in sarcoidosis.
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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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García de Tena J, El Hachem Debek A, Hernández Gutiérrez C, Izquierdo Alonso JL. The Role of Vitamin D in Chronic Obstructive Pulmonary Disease, Asthma and Other Respiratory Diseases. ACTA ACUST UNITED AC 2014. [DOI: 10.1016/j.arbr.2014.03.015] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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Tollitt J, Solomon L. Hypercalcaemia and acute kidney injury following administration of vitamin D in granulomatous disease. BMJ Case Rep 2014; 2014:bcr-2014-203824. [PMID: 24717583 DOI: 10.1136/bcr-2014-203824] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Vitamin D deficiency is common. It causes osteomalacia, may contribute to osteoporosis and is an independent risk factor for cancer, diabetes, multiple sclerosis, cardiovascular disease and all-cause mortality. We describe patients with a history of sarcoidosis who developed acute kidney injury due to hypercalcaemia following treatment with colecalciferol.
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Affiliation(s)
- James Tollitt
- Renal Unit, Lancashire Teaching Hospitals, Royal Preston Hospital, Lancashire, UK
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28
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Saidenberg-Kermanac'h N, Semerano L, Nunes H, Sadoun D, Guillot X, Boubaya M, Naggara N, Valeyre D, Boissier MC. Bone fragility in sarcoidosis and relationships with calcium metabolism disorders: a cross sectional study on 142 patients. Arthritis Res Ther 2014; 16:R78. [PMID: 24655357 PMCID: PMC4060172 DOI: 10.1186/ar4519] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2013] [Accepted: 03/04/2014] [Indexed: 02/07/2023] Open
Abstract
Introduction The prevention of fragility fractures in patients with sarcoidosis is a serious concern and the potential risk of hypercalcemia limits vitamin D and calcium supplementation. The objective of this study was to evaluate the risk factors for low bone mineral density (BMD) and fractures in sarcoidosis. In particular, we aimed to determine the link among bone fragility and calcium and vitamin D metabolism in this population. Methods We performed a cross-sectional analysis on 142 consecutive patients with histologically proven sarcoidosis. BMD and prevalence of vertebral fractures on X-rays were assessed and the association with potential risk factors was studied by regression analysis. Results Fragility fractures occurred in 23.5% of patients, despite a normal mean BMD in the study population. In a multivariate analysis, low dietary calcium, fracture, age, gender and menopause were associated with increased risk of low BMD. Low dietary calcium, high current corticosteroid dose and low creatinine clearance were associated with increased risk of fracture. Serum 25(OH)D between 10 and 20 ng/ml was significantly associated with higher BMD. Conversely, values greater than 20 ng/ml were associated with increased risk of fracture. Serum 25(OH)D level was inversely correlated with disease activity. Of note, vitamin D supplements increased serum 25(OH)D in a dose-dependent manner but had no effect on serum calcium level. Conclusions Sarcoidosis patients have a high risk of fracture despite not having a lowered BMD suggesting that other independent factors are involved. Current corticosteroid dose, low dietary calcium and serum 25(OH)D levels are associated with bone fragility. In sarcoidosis, calcium and vitamin D supplementation might be warranted, but desirable 25(OH)D serum levels might be lower than those advised for the general population.
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García de Tena J, El Hachem Debek A, Hernández Gutiérrez C, Izquierdo Alonso JL. The role of vitamin D in chronic obstructive pulmonary disease, asthma and other respiratory diseases. Arch Bronconeumol 2014; 50:179-84. [PMID: 24447429 DOI: 10.1016/j.arbres.2013.11.023] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2013] [Revised: 11/07/2013] [Accepted: 11/28/2013] [Indexed: 12/30/2022]
Abstract
There has been growing interest in recent years in the extraosseous effects of vitamin D. In this article, we review the physiology of vitamin D, the physiopathological effects associated with vitamin D deficit and the available evidence on its etiopathogenic role in respiratory diseases. Given the pleiotropic actions of vitamin D, it is biologically plausible that the deficit of this vitamin could play a pathogenic role of in the development of various respiratory diseases. However, the many epidemiological studies that have shown an association between low vitamin D levels and a higher risk of developing various respiratory diseases or a poorer prognosis if they do appear, were unable to show causality. Post-hoc analyses of some clinical trials, particularly in chronic obstructive pulmonary disease (COPD) and asthma, appear to suggest that some patient subtypes may benefit from correction of a vitamin D deficit. In this respect, it would be interesting to determine if the interindividual differences found in the effect of vitamin D deficit and responses to correcting this deficit could be explained by the genetic variants involved in vitamin D metabolism. Ultimately, only appropriately designed clinical trials will determine whether 25-OHD supplements can prevent or improve the course of the various respiratory diseases in which an epidemiological association between prognosis and vitamin D deficit has been described.
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Affiliation(s)
- Jaime García de Tena
- Servicio de Medicina Interna, Hospital Universitario de Guadalajara, Guadalajara, España; Departamento de Medicina y Especialidades Médicas, Universidad de Alcalá, Alcalá de Henares, España.
| | | | | | - José Luis Izquierdo Alonso
- Departamento de Medicina y Especialidades Médicas, Universidad de Alcalá, Alcalá de Henares, España; Servicio de Neumología, Hospital Universitario de Guadalajara, Guadalajara, España
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Abstract
Vitamin D is a dietary vitamin that can also be synthesized in adequate amounts from cholesterol in most mammals exposed to sunlight. Vitamin D has classical roles in calcium and phosphate metabolism, and thus the skeleton; however, this molecule also has nonclassical effects that might influence the function of the immune, cardiovascular and endocrine systems. Vitamin D deficiency, due to insufficient sunlight exposure, dietary uptake and/or abnormalities in its metabolism, has been associated with rheumatic diseases, and both the classical and nonclassical effects of vitamin D might be of relevance to patients with rheumatic disease. However, conclusive data from intervention trials demonstrating the relationship between vitamin D levels and pathogenetic processes separate from classical effects of this molecule are lacking. Furthermore, the majority of studies linking vitamin D to health outcomes, harmful or beneficial, are observational in nature, linking clinical events to vitamin D exposure or serum levels of vitamin D metabolites. Evidence from high quality, prospective, double-blind, placebo-controlled, randomized trials should be obtained before vitamin D supplementation is recommended in the treatment of the many rheumatic conditions in which deficiency of this compound has been implicated. Herein, we review the evidence for vitamin D supplementation in the management of patients with rheumatic diseases.
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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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How to diagnose and manage difficult problems of calcium metabolism in sarcoidosis. Curr Opin Pulm Med 2011; 17:297-302. [DOI: 10.1097/mcp.0b013e328348b3cb] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Sweiss NJ, Lower EE, Korsten P, Niewold TB, Favus MJ, Baughman RP. Bone health issues in sarcoidosis. Curr Rheumatol Rep 2011; 13:265-72. [PMID: 21327743 DOI: 10.1007/s11926-011-0170-1] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Sarcoidosis affects the bone directly in only a minority of patients. Nonetheless, bone health should be considered in the management of all patients with sarcoidosis. Deficiency in vitamin D, an important contributor to bone health, has been linked to autoimmune disease incidence. Studies have shown that patients with sarcoidosis frequently have low levels of vitamin D-25 but may have normal or increased levels of vitamin D-1,25. In addition, granuloma formation has been linked to a failure of the innate immune system, which could be related to a deficiency in vitamin D, although this relationship has not been fully characterized. Furthermore, many patients with sarcoidosis are treated with corticosteroids, which are known to induce osteoporosis. Therefore, bone health may be impacted in several ways in sarcoidosis--by direct involvement with granulomas, vitamin D deficiency, or corticosteroid therapy.
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Affiliation(s)
- Nadera J Sweiss
- Sections of Rheumatology and Pulmonary Medicine, University of Chicago Medical Center, 5841 South Maryland Avenue, MC0930, Room N005B, Chicago, IL 60637, USA.
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Sage RJ, Rao DS, Burke RR, Lim HW. Preventing vitamin D toxicity in patients with sarcoidosis. J Am Acad Dermatol 2011; 64:795-6. [PMID: 21414506 DOI: 10.1016/j.jaad.2010.05.022] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2010] [Revised: 05/04/2010] [Accepted: 05/11/2010] [Indexed: 11/24/2022]
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Proal AD, Albert PJ, Blaney GP, Lindseth IA, Benediktsson C, Marshall TG. Immunostimulation in the era of the metagenome. Cell Mol Immunol 2011; 8:213-25. [PMID: 21278764 PMCID: PMC4076734 DOI: 10.1038/cmi.2010.77] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2010] [Accepted: 12/15/2010] [Indexed: 12/15/2022] Open
Abstract
Microbes are increasingly being implicated in autoimmune disease. This calls for a re-evaluation of how these chronic inflammatory illnesses are routinely treated. The standard of care for autoimmune disease remains the use of medications that slow the immune response, while treatments aimed at eradicating microbes seek the exact opposite-stimulation of the innate immune response. Immunostimulation is complicated by a cascade of sequelae, including exacerbated inflammation, which occurs in response to microbial death. Over the past 8 years, we have collaborated with American and international clinical professionals to research a model-based treatment for inflammatory disease. This intervention, designed to stimulate the innate immune response, has required a reevaluation of disease progression and amelioration. Paramount is the inherent conflict between palliation and microbicidal efficacy. Increased microbicidal activity was experienced as immunopathology-a temporary worsening of symptoms. Further studies are needed, but they will require careful planning to manage this immunopathology.
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36
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El-Khoury JM, Reineks EZ, Wang S. Progress of liquid chromatography-mass spectrometry in measurement of vitamin D metabolites and analogues. Clin Biochem 2011; 44:66-76. [DOI: 10.1016/j.clinbiochem.2010.05.007] [Citation(s) in RCA: 85] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2010] [Revised: 05/05/2010] [Accepted: 05/10/2010] [Indexed: 11/16/2022]
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Bruce D, Ooi JH, Yu S, Cantorna MT. Vitamin D and host resistance to infection? Putting the cart in front of the horse. Exp Biol Med (Maywood) 2010; 235:921-7. [PMID: 20660091 DOI: 10.1258/ebm.2010.010061] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Vitamin D is being touted as an anti-infective agent and it has even been suggested that vitamin D supplementation could be effective against the H1N1 influenza virus. The claims are largely based on the ability of vitamin D to induce antibacterial peptides and evidence that the immune system produces active vitamin D (1,25(OH)(2)D(3)) in situ. While there are many examples of immune production of 1,25(OH)(2)D(3) in vitro, there is little in vivo evidence. In addition, it is not clear what role immune production of 1,25(OH)(2)D(3) has on the course of disease. Vitamin D and 1,25(OH)(2)D(3) inhibit T helper type 1 (Th1)/Th17-mediated immune responses and autoimmune diseases by acting on the innate and acquired immune system to inhibit the function of Th1 and Th17 cells. Th1 and Th17 cells are important in host resistance to many infections including tuberculosis (TB) caused by Mycobacterium tuberculosis. Paradoxically the innate immune system is induced to produce antibacterial peptides that are effective against TB in vitro. Data from several models of infection have so far not supported a role for vitamin D in affecting the course of disease. There is also very little evidence that vitamin D affects the course of human TB infection. Experiments have not been done in cells, mice or humans to evaluate the effect of vitamin D on influenza virus. At this time it would be premature to claim that vitamin D has an effect on TB, influenza or any other infection.
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Affiliation(s)
- Danny Bruce
- Department of Veterinary and Biomedical Science, Center for Molecular Immunology and Infectious Disease, The Pennsylvania State University, University Park, 16802, USA
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Burke RR, Rybicki BA, Rao DS. Calcium and vitamin D in sarcoidosis: how to assess and manage. Semin Respir Crit Care Med 2010; 31:474-84. [PMID: 20665397 DOI: 10.1055/s-0030-1262215] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
The synthesis of vitamin D is altered by the granulomatous inflammation of sarcoidosis leading to increased production of 1, 25-dihydroxyvitamin D. Mounting evidence suggests that vitamin D is an immunomodulating hormone that inhibits both antigen presentation by cells of the innate immune system, and the cytokine release and proliferation of Th1 cells. These and other extraskeletal health benefits have led to an increase in vitamin D assessment and pharmacological supplementation in the general population. This review highlights the altered synthesis and general immunomodulating properties of vitamin D with a special emphasis on known interactions with sarcoidosis. In addition, the assessment of vitamin D nutritional status, its pharmacological supplementation, and the management of bone health in patients with sarcoidosis are reviewed.
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Affiliation(s)
- Robert R Burke
- Department of Internal Medicine, Wayne State University School of Medicine, Detroit, MI 48202, USA.
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