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Veltkamp M. Clinical trials in pulmonary sarcoidosis; what is needed, what is happening and what is next? Curr Opin Pulm Med 2024; 30:576-582. [PMID: 38963156 DOI: 10.1097/mcp.0000000000001098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/05/2024]
Abstract
PURPOSE OF REVIEW There is a clinical unmet need to improve treatment for patients with pulmonary sarcoidosis. Both retrospective and prospective drug trials are hampered by the fact that patients with sarcoidosis are characterized by a heterogeneous presentation and disease course. In this review, an overview is given of different drug trials in pulmonary sarcoidosis with an emphasis on different primary endpoints and the problems related to them. RECENT FINDINGS In recent years, using significant input from patients with sarcoidosis, different task-forces/studies tried to develop a core set of most important outcomes to measure in future studies on treatment of sarcoidosis. Furthermore, at present, three major clinical trials are being conducted on new drugs for treatment of pulmonary sarcoidosis. SUMMARY Progress has been made to develop a core set of outcomes measures that can be used in making a combined primary endpoint in future drug trials in sarcoidosis.
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Affiliation(s)
- Marcel Veltkamp
- ILD Center of Excellence, member of European Reference Network-Lung, St Antonius Hospital, Nieuwegein, The Netherlands
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2
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Alsina-Restoy X, Torres-Castro R, Caballería E, Gimeno-Santos E, Solis-Navarro L, Francesqui J, Hernández-Gonzalez F, Ramos-Casals M, Blanco I, Sellarés J. Pulmonary rehabilitation in sarcoidosis: A systematic review and meta-analysis. Respir Med 2023; 219:107432. [PMID: 37858728 DOI: 10.1016/j.rmed.2023.107432] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2023] [Revised: 10/12/2023] [Accepted: 10/17/2023] [Indexed: 10/21/2023]
Abstract
BACKGROUND Exercise intolerance, muscle weakness, dyspnoea, and fatigue are frequent complications in symptomatic sarcoidosis patients. Pulmonary rehabilitation improves exercise capacity, symptoms, and quality of life in patients with chronic respiratory diseases. Our objective was to systematically determine the effects of pulmonary rehabilitation in patients with sarcoidosis. METHODS A systematic review was conducted in seven databases. Studies that applied pulmonary rehabilitation in patients with sarcoidosis were reviewed. Two independent reviewers analysed the studies, extracted the data and assessed the quality of evidence. RESULTS Of the 406 reports returned by the initial search, five articles reporting on 184 patients were included in the data synthesis. Two studies included multi-component exercise, one inspiratory muscle training, one a physical activity incentivisation programme, and one a telerehabilitation program. In the intervention group (IG), we found significant improvement in exercise capacity (SMD 1.65, 95%CI 0.45, 2.86 points, p = 0.006). If we only analyse the studies that performed the 6-min walking test, the IG walked 40.3 (CI95% 20.3, 60.2) m higher than the control group (CG) (p < 0.001). Additionally, dyspnoea score was reduced (MD -0.42 95%CI -0.75, -0.10, p = 0.002). However, fatigue, quality of life and pulmonary function did not show any change. CONCLUSION Pulmonary rehabilitation could improve exercise capacity and dyspnoea perception in patients with sarcoidosis.
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Affiliation(s)
- Xavier Alsina-Restoy
- Department of Pulmonary Medicine, Institut Clínic Respiratori, Hospital Clinic de Barcelona, Universitat de Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Rodrigo Torres-Castro
- Department of Pulmonary Medicine, Institut Clínic Respiratori, Hospital Clinic de Barcelona, Universitat de Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Department of Physical Therapy, Faculty of Medicine, University of Chile, Santiago, Chile
| | - Estrella Caballería
- Department of Pulmonary Medicine, Institut Clínic Respiratori, Hospital Clinic de Barcelona, Universitat de Barcelona, Spain
| | - Elena Gimeno-Santos
- Department of Pulmonary Medicine, Institut Clínic Respiratori, Hospital Clinic de Barcelona, Universitat de Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Instituto de Salud Global (ISGlobal), Barcelona, Spain
| | - Lilian Solis-Navarro
- Department of Physical Therapy, Faculty of Medicine, University of Chile, Santiago, Chile
| | - Joel Francesqui
- Department of Pulmonary Medicine, Institut Clínic Respiratori, Hospital Clinic de Barcelona, Universitat de Barcelona, Spain
| | - Fernanda Hernández-Gonzalez
- Department of Pulmonary Medicine, Institut Clínic Respiratori, Hospital Clinic de Barcelona, Universitat de Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | | | - Isabel Blanco
- Department of Pulmonary Medicine, Institut Clínic Respiratori, Hospital Clinic de Barcelona, Universitat de Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Center for Biomedical Network Research in Respiratory Diseases (CIBERES), Spain
| | - Jacobo Sellarés
- Department of Pulmonary Medicine, Institut Clínic Respiratori, Hospital Clinic de Barcelona, Universitat de Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Center for Biomedical Network Research in Respiratory Diseases (CIBERES), Spain.
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Moor CC, Obi ON, Kahlmann V, Buschulte K, Wijsenbeek MS. Quality of life in sarcoidosis. J Autoimmun 2023:103123. [PMID: 37813805 DOI: 10.1016/j.jaut.2023.103123] [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: 06/06/2023] [Accepted: 10/04/2023] [Indexed: 10/11/2023]
Abstract
Having sarcoidosis often has a major impact on quality of life of patients and their families. Improving quality of life is prioritized as most important treatment aim by many patients with sarcoidosis, but current evidence and treatment options are limited. In this narrative review, we describe the impact of sarcoidosis on various aspects of daily life, evaluate determinants of health-related quality of life (HRQoL), and provide an overview of the different patient-reported outcome measures to assess HRQoL in sarcoidosis. Moreover, we review the current evidence for pharmacological and non-pharmacological interventions to improve quality of life for people with sarcoidosis.
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Affiliation(s)
- Catharina C Moor
- Department of Respiratory Medicine, Centre of Excellence for Interstitial Lung Diseases and Sarcoidosis, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Ogugua Ndili Obi
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Internal Medicine, Brody School of Medicine, East Carolina University, Greenville, NC, USA
| | - Vivienne Kahlmann
- Department of Respiratory Medicine, Centre of Excellence for Interstitial Lung Diseases and Sarcoidosis, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Katharina Buschulte
- Center for Interstitial and Rare Lung Diseases, Pneumology and Respiratory Critical Care Medicine, Thoraxklinik, University of Heidelberg, German Center for Lung Research (DZL), Heidelberg, Germany
| | - Marlies S Wijsenbeek
- Department of Respiratory Medicine, Centre of Excellence for Interstitial Lung Diseases and Sarcoidosis, Erasmus Medical Center, Rotterdam, the Netherlands.
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Ezeh N, Caplan A, Rosenbach M, Imadojemu S. Cutaneous Sarcoidosis. Dermatol Clin 2023; 41:455-470. [DOI: 10.1016/j.det.2023.02.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/08/2023]
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Holas P, Figueira-Putresza E, Domagala-Kulawik J. Coping styles with stress and its relations to psychiatric and clinical symptoms in patients with sarcoidosis: A latent profile analysis. Respir Med 2023; 211:107171. [PMID: 36906186 DOI: 10.1016/j.rmed.2023.107171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 02/20/2023] [Accepted: 02/21/2023] [Indexed: 03/13/2023]
Abstract
OBJECTIVE Although stress and styles of coping with it can have a major impact on one's health and can determine the course and management of chronic diseases, no previous studies have evaluated coping strategies and their relation to emotional distress and clinical symptoms in sarcoidosis. METHODS In two consecutive studies, we investigated differences in coping styles of sarcoidosis patients in comparison to healthy control subjects and the association of identified profiles to an objective measurement of disease (Forced Vital Capacity) and symptoms such as dyspnoea, pain, anxiety and depressive symptoms in 36 patients with sarcoidosis (study 1) and 93 patients with sarcoidosis (study 2). RESULTS Across two studies we found that patients with sarcoidosis used emotion-focused and avoidant coping significantly less often than healthy individuals, and that in both groups the profile with dominant problem (task)-focus style was the most beneficial in terms of mental health. Further, the profile of sarcoidosis patients characterized by the lowest intensity of all coping strategies was found to be superior in terms of physical health status (dyspnoe, pain and FVC level). CONCLUSION These findings suggest that successful management of sarcoidosis should include coping styles assessment and call for a multidisciplinary approach in diagnosis and treatment of sarcoidosis patients.
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Affiliation(s)
- Pawel Holas
- University of Warsaw, Faculty of Psychology, Poland.
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Judson MA. The management of sarcoidosis in the 2020's by the primary care physician. Am J Med 2023; 136:534-544. [PMID: 36889493 DOI: 10.1016/j.amjmed.2023.02.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 02/20/2023] [Accepted: 02/20/2023] [Indexed: 03/08/2023]
Abstract
Sarcoidosis is an idiopathic granulomatous disease that occurs worldwide and may affect any organ. Because the presenting symptoms of sarcoidosis are not specific for the disease, the primary care physician is usually the first provider to assess these patients. In addition, patients who have previously been diagnosed with sarcoidosis are usually followed longitudinally by primary care physicians. Therefore, these physicians are often the first to address sarcoidosis patient symptoms related to exacerbations of the disease, as well as first observe complications of sarcoidosis medications. This article outlines the approach to the evaluation, treatment and monitoring of sarcoidosis patients by the primary care physician.
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Affiliation(s)
- Marc A Judson
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Albany Medical College, 16 New Scotland Avenue, Albany, New York 12208 USA.
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Lu Y, Zhao M. Adherence to 24-h movement guidelines and cognitive difficulties in adolescents. Complement Ther Clin Pract 2023; 51:101744. [PMID: 36921369 DOI: 10.1016/j.ctcp.2023.101744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 02/19/2023] [Accepted: 02/27/2023] [Indexed: 03/06/2023]
Abstract
BACKGROUND Studies have identified sleep, screen time, and physical activity as independent risk factors for cognitive impairment in adolescents. However, little is known about how these factors interact to contribute to cognitive difficulties. This study aimed to investigate the association between 24-h movement guidelines and cognitive difficulties in adolescents. METHODS Data from the 2019 Youth Risk Behaviour Surveillance was used for analysis. Participants self-reported their screen time, sleep, and physical activity levels, and cognitive difficulty was assessed using a standardized protocol with a binary response (Yes or No). Logistic regression analysis was used to evaluate the association between 24-h movement behaviours and cognitive difficulty, with results reported as the odds ratio (OR) with a 95% confidence interval (CI). RESULTS After controlling for covariates (e.g., sex, age), compared to adolescents not adhering to none of the 24-h movement guidelines, adhering to the screen time (OR = 1.68, 95%CI: 1.37-2.05) and sleep guidelines (OR = 1.32, 95%CI: 1.08-1.61) were more likely to report no cognitive difficulties in adolescents, respectively. Adhering to all the 24-h movement guidelines was also likely to increase the odds of reporting no cognitive difficulties (OR = 3.38, 95%: 2.15-5.30). CONCLUSIONS The study findings suggest that promoting better 24-h movement behaviours could be an effective approach to reducing cognitive difficulties in adolescents. Future studies should use improved study designs to confirm or refute these results.
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Affiliation(s)
- Yingna Lu
- School of Elite Sport, Shanghai University of Sport, Shanghai, China
| | - Mingren Zhao
- Faculty of Education, Shenzhen University, Shenzhen, China.
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Kahlmann V, Moor CC, van Helmondt SJ, Mostard RLM, van der Lee ML, Grutters JC, Wijsenbeek MS, Veltkamp M. Online mindfulness-based cognitive therapy for fatigue in patients with sarcoidosis (TIRED): a randomised controlled trial. THE LANCET. RESPIRATORY MEDICINE 2023; 11:265-272. [PMID: 36427515 DOI: 10.1016/s2213-2600(22)00387-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 09/16/2022] [Accepted: 09/16/2022] [Indexed: 11/24/2022]
Abstract
BACKGROUND Sarcoidosis-associated fatigue is highly prevalent and is often reported as the most burdensome symptom of sarcoidosis. Management of fatigue is challenging, and evidence-based therapies are lacking. In this TIRED trial, we aimed to assess the effects of a 12-week online mindfulness-based cognitive therapy (eMBCT) on fatigue. METHODS This study was a prospective, open-label, multicentre randomised controlled trial, conducted at three centres in the Netherlands. Eligible patients were 18 years or older, had stable sarcoidosis, and a score of more than 21 points on the Fatigue Assessment Scale (FAS). Patients were randomised into either the eMBCT or the control group. Participants completed patient-reported outcome measures at baseline, after intervention (T1), and 12 weeks after completion of eMBCT (T2). The primary outcome was the change in FAS score at T1 in the eMBCT group compared with the control group, assessed with the independent students't test in all patients who started the study. Secondary outcomes included within-group difference in FAS score at T1 and T2, between-group difference in FAS score at T2, and changes in the Hospital Anxiety and Depression Scale, the Freiburg Mindfulness Inventory-Short Form, and the Kings Sarcoidosis Questionnaire. The study was registered at the Netherlands Trial Register, NL7816. FINDINGS Between June 5, 2019, and Oct 28, 2021, 99 patients were randomly assigned to the eMBCT (n=52) or the control (n=47) groups. Six patients withdrew consent after psychological screening before the start of eMBCT. Baseline FAS score was similar in both groups (34·57 [SD 6·07] for 46 patients in the eMBCT group and 35·51 [4·65] for 47 patients in the control group). Mean change in FAS score at T1 was -4·53 (SD 5·77; p<0·0001) in the eMBCT group and -1·28 (3·80; p=0·026) in the control group (between-group difference 3·26 [95% CI 1·18 to 5·33; p=0·0025]). Furthermore, the eMBCT group had a significant improvement in anxiety (mean between-group difference 1·69, 95% CI 0·22-3·16; p=0·025), depressive symptoms (1·52, 0·08-2·95; p=0·039), mindfulness (3·1, 0·70-5·49; p=0·022), and general health status (6·28, 2·51-10·06; p=0·002) at T1, compared with the control group. INTERPRETATION 12 week eMBCT improves fatigue, anxiety, depression, mindfulness, and health status in patients with sarcoidosis-associated fatigue. FUNDING Dutch Sarcoidosis Patient Association (Sarcoidose.nl). TRANSLATION For the Dutch translation of the summary see Supplementary Materials section.
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Affiliation(s)
- Vivienne Kahlmann
- Center of Excellence for Interstitial Lung Diseases and Sarcoidosis, Department of Respiratory Medicine, Erasmus Medical Center-University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Catharina C Moor
- Center of Excellence for Interstitial Lung Diseases and Sarcoidosis, Department of Respiratory Medicine, Erasmus Medical Center-University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Sanne J van Helmondt
- ILD Center of Excellence, Department of Pulmonology, St Antonius Hospital, Nieuwegein, Netherlands
| | - Rémy L M Mostard
- Department of Respiratory Medicine, Zuyderland Medical Center, Heerlen, Netherlands; Department of Respiratory Medicine, Maastricht University Medical Center (MUMC+), Maastricht, Netherlands
| | - Marije L van der Lee
- Scientific Research Department, Helen Dowling Institute, Bilthoven, Netherlands; Department of Medical and Clinical Psychology, Center of Research on Psychology in Somatic diseases (CoRPS), Tilburg University, Tilburg, Netherlands
| | - Jan C Grutters
- ILD Center of Excellence, Department of Pulmonology, St Antonius Hospital, Nieuwegein, Netherlands; Division of Heart and Lungs, University Medical Center Utrecht, Utrecht, Netherlands
| | - Marlies S Wijsenbeek
- Center of Excellence for Interstitial Lung Diseases and Sarcoidosis, Department of Respiratory Medicine, Erasmus Medical Center-University Medical Center Rotterdam, Rotterdam, Netherlands.
| | - Marcel Veltkamp
- ILD Center of Excellence, Department of Pulmonology, St Antonius Hospital, Nieuwegein, Netherlands; Division of Heart and Lungs, University Medical Center Utrecht, Utrecht, Netherlands
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Patel H, Shah JR, Patel DR, Avanthika C, Jhaveri S, Gor K. Idiopathic pulmonary fibrosis: Diagnosis, biomarkers and newer treatment protocols. Dis Mon 2022:101484. [DOI: 10.1016/j.disamonth.2022.101484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Abstract
PURPOSE OF REVIEW Ageing, the accrual of molecular and cellular damage over a lifetime confers progressive physiologic dysfunction of bodily systems, leaving the body in a heightened state of vulnerability to biophysical and psychosocial stressors. The inflection point is frailty which easily leads to disability and death. Interstitial lung disease (ILD) creates biophysical and psychosocial stresses difficult for even optimally fit patients to cope with. With evolving ILD treatment pathways, people with ILD are living longer. RECENT FINDINGS ILD and ageing are bi-directionally influential: ILD, its treatments, complications, and collateral systemic extra-pulmonary damage (hypoxic and oxidative stress) wear on the ageing person and ageing impacts a person's tolerance of ILD. ILD extent may proportionally accelerate age-related vulnerabilities. ILD related to inflammatory systemic diseases, e.g. connective tissue diseases or sarcoidosis, exert an even more complex biophysical impact on the body. SUMMARY The present review stresses goals of preventing frailty in ILD and preserving general health and well being of people living with ILD of any age, from time of diagnosis and as they age. The development of a prediction score is proposed to classify those at risk of frailty and guide interventions that preserve successful ageing for all levels of ILD severity. VIDEO ABSTRACT http://links.lww.com/COPM/A32.
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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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Byg KE, Illes Z, Sejbaek T, Nguyen N, Möller S, Lambertsen KL, Nielsen HH, Ellingsen T. A prospective, one-year follow-up study of patients newly diagnosed with neurosarcoidosis. J Neuroimmunol 2022; 369:577913. [PMID: 35717739 DOI: 10.1016/j.jneuroim.2022.577913] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 02/07/2022] [Accepted: 06/06/2022] [Indexed: 10/18/2022]
Abstract
METHODS Twenty patients with newly diagnosed neurosarcoidosis were examined for multiple outcomes in an observational cohort study with 12-month follow-up. RESULTS The patients' contrast-enhancing lesions on MRI scans reduced during treatment (p < 0.0001). The mean modified Rankin Score improved from 3.0 to 1.8 (p < 0.0001), and 75% of patients experienced clinically important improvement. Patients improved on the Symbol Digit Modalities Test (p < 0.0001) and on SF-36 Physical (p = 0.003) and Mental Component Summary scores (p = 0.03). Proportions of patients with substantial fatigue (75%) and high depression score (35%) were unchanged. CONCLUSIONS 12-month immunosuppression improved several outcomes, and 75% of patients experienced clinically important improvement.
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Affiliation(s)
- Keld-Erik Byg
- Rheumatology Research Unit, Odense University Hospital, J.B. Winsloewsvej 4, 5000 Odense, Denmark; Department of Neurology, Odense University Hospital, J.B. Winsloewsvej 4, 5000 Odense, Denmark; BRIDGE-Brain Research-Inter-Disciplinary Guided Excellence, Department of Clinical Research, University of Southern Denmark, J.B. Winsloewsvej 19, 5000 Odense, Denmark; Department of Clinical Research, University of Southern Denmark, J.B. Winsloewsvej 19, 5000 Odense, Denmark.
| | - Zsolt Illes
- Department of Neurology, Odense University Hospital, J.B. Winsloewsvej 4, 5000 Odense, Denmark; BRIDGE-Brain Research-Inter-Disciplinary Guided Excellence, Department of Clinical Research, University of Southern Denmark, J.B. Winsloewsvej 19, 5000 Odense, Denmark; Department of Neurobiology Research, Institute of Molecular Medicine, University of Southern Denmark, J.B. Winsloewsvej 21, 5000 Odense, Denmark
| | - Tobias Sejbaek
- BRIDGE-Brain Research-Inter-Disciplinary Guided Excellence, Department of Clinical Research, University of Southern Denmark, J.B. Winsloewsvej 19, 5000 Odense, Denmark; Department of Neurology, South West Jutland University Hospital of Southern Denmark, Finsensgade 35, 6700 Esbjerg, Denmark; Department of Regional Health Research, University of Southern Denmark, J.B. Winsloewsvej 19, 5000 Odense, Denmark
| | - Nina Nguyen
- Department of Radiology, Odense University Hospital, J.B. Winsloewsvej 4, 5000 Odense, Denmark
| | - Sören Möller
- Department of Clinical Research, University of Southern Denmark, J.B. Winsloewsvej 19, 5000 Odense, Denmark; Open Patient data Explorative Network, Odense University Hospital, J.B. Winsloewsvej 9a, 5000 Odense, Denmark
| | - Kate L Lambertsen
- BRIDGE-Brain Research-Inter-Disciplinary Guided Excellence, Department of Clinical Research, University of Southern Denmark, J.B. Winsloewsvej 19, 5000 Odense, Denmark; Department of Neurobiology Research, Institute of Molecular Medicine, University of Southern Denmark, J.B. Winsloewsvej 21, 5000 Odense, Denmark
| | - Helle H Nielsen
- Department of Neurology, Odense University Hospital, J.B. Winsloewsvej 4, 5000 Odense, Denmark; BRIDGE-Brain Research-Inter-Disciplinary Guided Excellence, Department of Clinical Research, University of Southern Denmark, J.B. Winsloewsvej 19, 5000 Odense, Denmark; Department of Neurobiology Research, Institute of Molecular Medicine, University of Southern Denmark, J.B. Winsloewsvej 21, 5000 Odense, Denmark
| | - Torkell Ellingsen
- Rheumatology Research Unit, Odense University Hospital, J.B. Winsloewsvej 4, 5000 Odense, Denmark; Department of Clinical Research, University of Southern Denmark, J.B. Winsloewsvej 19, 5000 Odense, Denmark
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Jamilloux Y, El Jammal T, Bert A, Sève P. [Hydroxychloroquine for non-severe extra-pulmonary sarcoidosis]. Rev Med Interne 2022; 43:406-411. [PMID: 35660263 DOI: 10.1016/j.revmed.2022.04.030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 03/11/2022] [Accepted: 04/21/2022] [Indexed: 01/08/2023]
Abstract
Sarcoidosis can develop into a chronic disease in about 30% of cases. When general treatment is indicated, corticosteroids are the first-line treatment. More than one third of patients treated with corticosteroids receive a steroid-sparing agent. Although methotrexate is the most commonly used sparing agent, synthetic antimalarials have been used for more than fifty years on the basis of small, randomised, therapeutic trials. Despite this low level of evidence, chloroquine or more often hydroxychloroquine are used in daily practice, particularly to treat skin, bone and joint sarcoidosis, as well as hypercalcemia and certain types of uveitis. This review summarises the state of knowledge on steroid-sparing therapy in sarcoidosis, particularly in its extra-pulmonary form. These data support the need for good quality therapeutic trials to validate the use of hydroxychloroquine in this specific indication.
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Affiliation(s)
- Y Jamilloux
- Service de médecine interne, hôpital de la Croix-Rousse, Hospices Civils de Lyon, Université Claude Bernard-Lyon 1, 103, grande rue de la Croix Rousse, 69004 Lyon, France; Lyon Immunopathology FEderation (LIFE), Université Claude Bernard-Lyon 1, Lyon, France.
| | - T El Jammal
- Service de médecine interne, hôpital de la Croix-Rousse, Hospices Civils de Lyon, Université Claude Bernard-Lyon 1, 103, grande rue de la Croix Rousse, 69004 Lyon, France
| | - A Bert
- Service de médecine interne, hôpital de la Croix-Rousse, Hospices Civils de Lyon, Université Claude Bernard-Lyon 1, 103, grande rue de la Croix Rousse, 69004 Lyon, France
| | - P Sève
- Service de médecine interne, hôpital de la Croix-Rousse, Hospices Civils de Lyon, Université Claude Bernard-Lyon 1, 103, grande rue de la Croix Rousse, 69004 Lyon, France; Université Claude Bernard-Lyon 1, Research on Healthcare Performance (RESHAPE), Inserm U1290, Lyon, France
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Melani AS, Simona A, Armati M, d’Alessandro M, Bargagli E. A Comprehensive Review of Sarcoidosis Diagnosis and Monitoring for the Pulmonologist. Pulm Ther 2021; 7:309-324. [PMID: 34091831 PMCID: PMC8589876 DOI: 10.1007/s41030-021-00161-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Accepted: 05/17/2021] [Indexed: 12/05/2022] Open
Abstract
Sarcoidosis is a systemic granulomatous disease with heterogenous clinical manifestations. Here we review the diagnosis of sarcoidosis and propose a clinically feasible diagnostic work-up and monitoring protocol. As sarcoidosis is a systemic disease, a multidisciplinary approach is recommended for best outcomes. However, since the lungs are frequently involved, the pulmonologist is often the referral physician for diagnosis and management. When sarcoidosis is suspected, diagnosis needs to be confirmed and organ involvement/impairment assessed. This process is also required to establish whether the patient is likely to benefit from treatment, as many cases of sarcoidosis are self-limited and remit spontaneously. Whether or not treatment is started, effective regular follow-up is necessary to monitor changes in the disease, including extension, progression, remissions, flare-ups, and complications.
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Affiliation(s)
- Andrea S. Melani
- UOS Pneumologia/UTIP, Dip. Scienze Mediche, Chirurgiche E Neuroscienze, Policlinico Le Scotte Viale Bracci, Azienda Ospedaliera Senese, 53100 Siena, Italy
| | - Albano Simona
- UOS Pneumologia/UTIP, Dip. Scienze Mediche, Chirurgiche E Neuroscienze, Policlinico Le Scotte Viale Bracci, Azienda Ospedaliera Senese, 53100 Siena, Italy
| | - Martina Armati
- UOC Malattie Respiratorie, Dip. Scienze Mediche, Chirurgiche E Neuroscienze Università Di Siena Policlinico “Le Scotte”, Siena, Italy
| | - Miriana d’Alessandro
- UOC Malattie Respiratorie, Dip. Scienze Mediche, Chirurgiche E Neuroscienze Università Di Siena Policlinico “Le Scotte”, Siena, Italy
- UOC Malattie Respiratorie, Immunoallergology, Rare Respiratory Diseases and Lung Transplant Laboratory, Dip. Scienze Mediche, Chirurgiche E Neuroscienze Università Di Siena Policlinico “Le Scotte”, Siena, Italy
| | - Elena Bargagli
- UOC Malattie Respiratorie, Dip. Scienze Mediche, Chirurgiche E Neuroscienze Università Di Siena Policlinico “Le Scotte”, Siena, Italy
- UOC Malattie Respiratorie, Immunoallergology, Rare Respiratory Diseases and Lung Transplant Laboratory, Dip. Scienze Mediche, Chirurgiche E Neuroscienze Università Di Siena Policlinico “Le Scotte”, Siena, Italy
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15
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Affiliation(s)
- Marjolein Drent
- From the Interstitial Lung Diseases (ILD) Center of Excellence, Department of Pulmonology, St. Antonius Hospital, Nieuwegein, the Department of Pharmacology and Toxicology, Faculty of Health and Life Sciences, Maastricht University, Maastricht, and the ILD Care Foundation Research Team, Ede - all in the Netherlands (M.D.); the Division of Pulmonary, Critical Care, and Sleep Medicine, Ohio State University, Columbus (E.D.C.); and the Respiratory Medicine Division, Department of Medicine Solna, and the Center for Molecular Medicine, Karolinska Institutet, and Respiratory Medicine, Theme Inflammation and Aging, Karolinska University Hospital - both in Stockholm (J.G.)
| | - Elliott D Crouser
- From the Interstitial Lung Diseases (ILD) Center of Excellence, Department of Pulmonology, St. Antonius Hospital, Nieuwegein, the Department of Pharmacology and Toxicology, Faculty of Health and Life Sciences, Maastricht University, Maastricht, and the ILD Care Foundation Research Team, Ede - all in the Netherlands (M.D.); the Division of Pulmonary, Critical Care, and Sleep Medicine, Ohio State University, Columbus (E.D.C.); and the Respiratory Medicine Division, Department of Medicine Solna, and the Center for Molecular Medicine, Karolinska Institutet, and Respiratory Medicine, Theme Inflammation and Aging, Karolinska University Hospital - both in Stockholm (J.G.)
| | - Johan Grunewald
- From the Interstitial Lung Diseases (ILD) Center of Excellence, Department of Pulmonology, St. Antonius Hospital, Nieuwegein, the Department of Pharmacology and Toxicology, Faculty of Health and Life Sciences, Maastricht University, Maastricht, and the ILD Care Foundation Research Team, Ede - all in the Netherlands (M.D.); the Division of Pulmonary, Critical Care, and Sleep Medicine, Ohio State University, Columbus (E.D.C.); and the Respiratory Medicine Division, Department of Medicine Solna, and the Center for Molecular Medicine, Karolinska Institutet, and Respiratory Medicine, Theme Inflammation and Aging, Karolinska University Hospital - both in Stockholm (J.G.)
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16
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Saketkoo LA, Russell AM, Jensen K, Mandizha J, Tavee J, Newton J, Rivera F, Howie M, Reese R, Goodman M, Hart P, Strookappe B, De Vries J, Rosenbach M, Scholand MB, Lammi MR, Elfferich M, Lower E, Baughman RP, Sweiss N, Judson MA, Drent M. Health-Related Quality of Life (HRQoL) in Sarcoidosis: Diagnosis, Management, and Health Outcomes. Diagnostics (Basel) 2021; 11:1089. [PMID: 34203584 PMCID: PMC8232334 DOI: 10.3390/diagnostics11061089] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 05/30/2021] [Accepted: 06/02/2021] [Indexed: 02/06/2023] Open
Abstract
Health-related quality of life (HRQoL), though rarely considered as a primary endpoint in clinical trials, may be the single outcome reflective of patient priorities when living with a health condition. HRQoL is a multi-dimensional concept that reflects the degree to which a health condition interferes with participation in and fulfillment of important life areas. HRQoL is intended to capture the composite degree of physical, physiologic, psychological, and social impairment resulting from symptom burden, patient-perceived disease severity, and treatment side effects. Diminished HRQoL expectedly correlates to worsening disability and death; but interventions addressing HRQoL are linked to increased survival. Sarcoidosis, being a multi-organ system disease, is associated with a diffuse array of manifestations resulting in multiple symptoms, complications, and medication-related side effects that are linked to reduced HRQoL. Diminished HRQoL in sarcoidosis is related to decreased physical function, pain, significant loss of income, absence from work, and strain on personal relationships. Symptom distress can result clearly from a sarcoidosis manifestation (e.g., ocular pain, breathlessness, cough) but may also be non-specific, such as pain or fatigue. More complex, a single non-specific symptom, e.g., fatigue may be directly sarcoidosis-derived (e.g., inflammatory state, neurologic, hormonal, cardiopulmonary), medication-related (e.g., anemia, sleeplessness, weight gain, sub-clinical infection), or an indirect complication (e.g., sleep apnea, physical deconditioning, depression). Identifying and distinguishing underlying causes of impaired HRQoL provides opportunity for treatment strategies that can greatly impact a patient's function, well-being, and disease outcomes. Herein, we present a reference manual that describes the current state of knowledge in sarcoidosis-related HRQoL and distinguish between diverse causes of symptom distress and other influences on sarcoidosis-related HRQoL. We provide tools to assess, investigate, and diagnose compromised HRQoL and its influencers. Strategies to address modifiable HRQoL factors through palliation of symptoms and methods to improve the sarcoidosis health profile are outlined; as well as a proposed research agenda in sarcoidosis-related HRQoL.
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Affiliation(s)
- Lesley Ann Saketkoo
- New Orleans Scleroderma and Sarcoidosis Patient Care and Research Center, New Orleans, LA 70112, USA; (K.J.); (M.R.L.)
- Comprehensive Pulmonary Hypertension Center and Interstitial Lung Disease Clinic Programs, University Medical Center, New Orleans, LA 70112, USA
- Section of Pulmonary Medicine, Louisiana State University School of Medicine, New Orleans, LA 70112, USA
- Tulane University School of Medicine, Tulane University, New Orleans, LA 70112, USA
| | - Anne-Marie Russell
- College of Medicine and Health, University of Exeter, Devon EX1 2LU, UK
- Imperial College Healthcare NHS Foundation Trust, London W2 1NY, UK
| | - Kelly Jensen
- New Orleans Scleroderma and Sarcoidosis Patient Care and Research Center, New Orleans, LA 70112, USA; (K.J.); (M.R.L.)
- Tulane University School of Medicine, Tulane University, New Orleans, LA 70112, USA
- Department of Internal Medicine, Oregon Health and Science University, Portland, OR 97239, USA
| | - Jessica Mandizha
- Respiratory Medicine, Royal Devon and Exeter Hospital NHS Foundation Trust, Exeter EX2 5DW, UK;
| | - Jinny Tavee
- Department of Neurology, National Jewish Health, Denver, CO 80206, USA;
| | - Jacqui Newton
- Sarcoidosis UK, China Works, Black Prince Road, London SE1 7SJ, UK; (J.N.); (M.H.)
| | - Frank Rivera
- Foundation for Sarcoidosis Research, Chicago, IL 60614, USA; (F.R.); (R.R.)
- National Sarcoidosis Support Group, Stronger than Sarcoidosis, New York, NY 11727, USA
| | - Mike Howie
- Sarcoidosis UK, China Works, Black Prince Road, London SE1 7SJ, UK; (J.N.); (M.H.)
- CGI UK, Space Defense & Intelligence (Cyber Security Operations), London EC3M 3BY, UK
| | - Rodney Reese
- Foundation for Sarcoidosis Research, Chicago, IL 60614, USA; (F.R.); (R.R.)
- National Sarcoidosis Support Group, Stronger than Sarcoidosis, New York, NY 11727, USA
- Sarcoidosis Awareness Foundation of Louisiana, Baton Rouge, LA 70812, USA
| | - Melanie Goodman
- New Orleans Sarcoidosis Support Group, New Orleans, LA 70112, USA;
| | - Patricia Hart
- iHart Wellness Holistic Approach to Sarcoidosis Certified Health & Wellness Coach, International Association of Professionals, New York, NY 11727, USA;
| | - Bert Strookappe
- Department of Physiotherapy, Gelderse Vallei Hospital, 10, 6716 RP Ede, The Netherlands; (B.S.); (M.E.)
- ildcare Foundation Research Team, 6711 NR Ede, The Netherlands; (M.D.)
| | - Jolanda De Vries
- Admiraal de Ruyter Hospital (Adrz), 114, 4462 RA Goes, The Netherlands;
- Department of Medical and Clinical Psychology, Tilburg University, 5037 AB Tilburg, The Netherlands
| | - Misha Rosenbach
- Cutaneous Sarcoidosis Clinic, Department of Dermatology, University of Pennsylvania, Philadelphia, PA 19104, USA;
| | - Mary Beth Scholand
- Division of Pulmonary Medicine, Interstitial Lung Disease Center, University of Utah, Salt Lake City, UT 84132, USA;
| | - Mathew R. Lammi
- New Orleans Scleroderma and Sarcoidosis Patient Care and Research Center, New Orleans, LA 70112, USA; (K.J.); (M.R.L.)
- Comprehensive Pulmonary Hypertension Center and Interstitial Lung Disease Clinic Programs, University Medical Center, New Orleans, LA 70112, USA
- Section of Pulmonary Medicine, Louisiana State University School of Medicine, New Orleans, LA 70112, USA
| | - Marjon Elfferich
- Department of Physiotherapy, Gelderse Vallei Hospital, 10, 6716 RP Ede, The Netherlands; (B.S.); (M.E.)
- ildcare Foundation Research Team, 6711 NR Ede, The Netherlands; (M.D.)
| | - Elyse Lower
- Department of Medicine, University of Cincinnati Medical Center, Cincinnati, OH 45267, USA; (E.L.); (R.P.B.)
| | - Robert P. Baughman
- Department of Medicine, University of Cincinnati Medical Center, Cincinnati, OH 45267, USA; (E.L.); (R.P.B.)
| | - Nadera Sweiss
- Division of Rheumatology, Department of Medicine, University of Illinois at Chicago, Chicago, IL 60612, USA;
| | - Marc A. Judson
- Division of Pulmonary Medicine and Critical Care, Albany Medical College, Albany, NY 12208, USA;
| | - Marjolein Drent
- ildcare Foundation Research Team, 6711 NR Ede, The Netherlands; (M.D.)
- Interstitial Lung Diseases (ILD) Center of Excellence, Department of Pulmonology, St. Antonius Hospital, Koekoekslaan 1, 3435 CM Nieuwegein, The Netherlands
- Department of Pharmacology and Toxicology, Faculty of Health and Life Sciences, Maastricht University, 40, 6229 ER Maastricht, The Netherlands
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17
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Drent M, Elfferich M, Breedveld E, Vries JD, Strookappe B. Benefit of Wearing an Activity Tracker in Sarcoidosis. J Pers Med 2020; 10:jpm10030097. [PMID: 32842583 PMCID: PMC7563218 DOI: 10.3390/jpm10030097] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 08/17/2020] [Accepted: 08/20/2020] [Indexed: 12/14/2022] Open
Abstract
Sarcoidosis causes many disabling symptoms, including fatigue and exercise limitations, which have been shown to improve by physical activity programs. The aim of this study was to estimate the effect of continuous activity monitoring using an electronic activity tracker (AT) on exercise performance and fatigue of sarcoidosis patients, compared to controls (cohort study), and the effect of additional personal coaching (randomized trial) over a period of 3 months. Fifty-four sarcoidosis patients received an AT (Group Ia: 27 with coaching and Group Ib: 27 without). A historical group of sarcoidosis patients (Group II; n = 41) who did not follow a physical activity program served as controls. Exercise performance of patients wearing an AT (Group I) improved compared with controls (Group II), including the 6MWD, % predicted (∆4.4 ± 9.1 versus ∆0.7 ± 5.0, respectively), and fatigue levels decreased (∆−3.9 ± 5.7 versus ∆−1.8 ± 5.3). Patients with coaching (Group Ia) showed greater improvement of exercise capacity over time than patients without coaching (Group Ib) as shown by the Steep Ramp Test results (watts: ∆20.2 ± 33.8 versus ∆5.7 ± 26.4; and SRT, VO2max, % predicted: ∆1.6 ± 2.6 versus ∆0.7 ± 2.3). Sarcoidosis patients wearing an AT achieved improvement of exercise performance and reduction of fatigue. We therefore recommend encouraging sarcoidosis patients to wear an AT to stimulate physical activity and reduce fatigue. The additional benefit of coaching needs to be explored in future studies.
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Affiliation(s)
- Marjolein Drent
- ILD Care Foundation Research Team, 6711 NR Ede, The Netherlands; (M.E.); (E.B.); (J.D.V.); (B.S.)
- ILD Center of Excellence, Department of Pulmonology, St. Antonius Hospital, 3435 CM Nieuwegein, The Netherlands
- Department of Pharmacology and Toxicology, FHML, University Maastricht, 6211 LK Maastricht, The Netherlands
- Correspondence: ; Tel.: +31-620449319
| | - Marjon Elfferich
- ILD Care Foundation Research Team, 6711 NR Ede, The Netherlands; (M.E.); (E.B.); (J.D.V.); (B.S.)
- Department of Physical Therapy, Hospital Gelderse Vallei, 6716 RP Ede, The Netherlands
| | - Ellen Breedveld
- ILD Care Foundation Research Team, 6711 NR Ede, The Netherlands; (M.E.); (E.B.); (J.D.V.); (B.S.)
- Department of Physical Therapy, Hospital Gelderse Vallei, 6716 RP Ede, The Netherlands
| | - Jolanda De Vries
- ILD Care Foundation Research Team, 6711 NR Ede, The Netherlands; (M.E.); (E.B.); (J.D.V.); (B.S.)
- Department of Medical Psychology, Elisabeth-TweeSteden Hospital Tilburg, 5042 AD Tilburg, The Netherlands
- Department of Medical and Clinical Psychology, Tilburg University, 5037 AB Tilburg, The Netherlands
| | - Bert Strookappe
- ILD Care Foundation Research Team, 6711 NR Ede, The Netherlands; (M.E.); (E.B.); (J.D.V.); (B.S.)
- Department of Physical Therapy, Hospital Gelderse Vallei, 6716 RP Ede, The Netherlands
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18
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Voortman M, Stern BJ, Saketkoo LA, Drent M. The Burden of Neurosarcoidosis: Essential Approaches to Early Diagnosis and Treatment. Semin Respir Crit Care Med 2020; 41:641-651. [PMID: 32777849 DOI: 10.1055/s-0040-1710576] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Neurosarcoidosis (NS) is an often severe, destructive manifestation with a likely under-reported prevalence of 5 to 15% of sarcoidosis cases, and in its active phase demands timely treatment intervention. Clinical signs and symptoms of NS are variable and wide-ranging, depending on anatomical involvement. Cranial nerve dysfunction, cerebrospinal parenchymal disease, aseptic meningitis, and leptomeningeal disease are the most commonly recognized manifestations. However, non-organ-specific potentially neurologically driven symptoms, such as fatigue, cognitive dysfunction, and small fiber neuropathy, appear frequently.Heterogeneous clinical presentations and absence of any single conclusive test or biomarker render NS, and sarcoidosis itself, a challenging definitive diagnosis. Clinical suspicion of NS warrants a thorough systemic and neurologic evaluation hopefully resulting in supportive extraneural physical exam and/or tissue findings. Treatment targets the severity of the manifestation, with careful discernment of whether NS reflects active potentially reversible inflammatory granulomatous disease versus inactive postinflammatory damage whereby functional impairment is unlikely to be pharmacologically responsive. Non-organ-specific symptoms are poorly understood, challenging in deciphering reversibility and often identified too late to respond to conventional immunosuppressive/pharmacological treatment. Physical therapy, coping strategies, and stress reduction may benefit patients with all disease activity levels of NS.This publication provides an approach to screening, diagnosis, disease activity discernment, and pharmacological as well as nonpharmacological treatment interventions to reduce disability and protect health-related quality of life in NS.
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Affiliation(s)
- Mareye Voortman
- Division of Heart and Lungs, Department of Pulmonology, University Medical Centre Utrecht, The Netherlands.,ILD Care Foundation Research Team, Ede, The Netherlands
| | - Barney J Stern
- Department of Neurology, Johns Hopkins University, Baltimore, Maryland
| | - Lesley Ann Saketkoo
- New Orleans Scleroderma and Sarcoidosis Patient Care and Research Center, New Orleans, Louisiana.,Comprehensive Pulmonary Hypertension Center and Interstitial Lung Disease Clinic Programs, University Medical Center, New Orleans, Louisiana.,Louisiana State University and Tulane University Schools of Medicine, New Orleans, Louisiana
| | - Marjolein Drent
- ILD Care Foundation Research Team, Ede, The Netherlands.,Department of Pharmacology and Toxicology, FHML, Maastricht University, Maastricht, The Netherlands.,Department of Pulmonology, ILD Center of Excellence, St. Antonius Hospital, Nieuwegein, The Netherlands
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Abstract
As sarcoidosis may involve any organ, sarcoidosis patients should be evaluated for occult disease. Screening for some organ involvement may not be warranted if it is unlikely to cause symptoms, organ dysfunction, or affect clinical outcome. Even organ involvement that affects clinical outcome does not necessarily require screening if early detection fails to change the patient's quality of life or prognosis. On the other hand, early detection of some forms of sarcoidosis may improve outcomes and survival. This manuscript describes the approach to screening sarcoidosis patients for previously undetected disease. Screening for sarcoidosis should commence with a meticulous medical history and physical examination. Many sarcoidosis patients present with physical signs or symptoms of sarcoidosis that have not been recognized as manifestations of the disease. Detection of sarcoidosis in these instances depends on the clinician's familiarity with the varied clinical presentations of sarcoidosis. In addition, sarcoidosis patients may present with symptoms or signs that are not related to specific organ involvement that have been described as parasarcoidosis syndromes. It is conjectured that parasarcoidosis syndromes result from systemic release of inflammatory mediators from the sarcoidosis granuloma. Certain forms of sarcoidosis may cause permanent and serious problems that can be prevented if they are detected early in the course of their disease. These include (1) ocular involvement that may lead to permanent vision impairment; (2) vitamin D dysregulation that may lead to hypercalcemia, nephrolithiasis, and permanent kidney injury; and (3) cardiac sarcoidosis that may lead to a cardiomyopathy, ventricular arrhythmias, heart block, and sudden death. Screening for these forms of organ involvement requires detailed screening approaches.
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Affiliation(s)
- Marc A Judson
- Division of Pulmonary and Critical Care Medicine, Albany Medical College, Albany, New York
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20
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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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21
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Managing Fatigue in Patients With Interstitial Lung Disease. Chest 2020; 158:2026-2033. [PMID: 32387518 PMCID: PMC7674989 DOI: 10.1016/j.chest.2020.04.047] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Revised: 03/25/2020] [Accepted: 04/12/2020] [Indexed: 12/17/2022] Open
Abstract
Fatigue is one of the most burdensome symptoms in interstitial lung disease (ILD) and can have a major impact on quality of life, social interactions, and work capacity. The cause of fatigue is complex; it is caused or aggravated by a combination of different predisposing, precipitating, and perpetuating factors. There is no uniform definition of fatigue, but it is often divided in physical and mental components. Several validated questionnaires can be used for structural assessment of fatigue in daily care. Although the high burden of fatigue in ILD is recognized increasingly, studies that have investigated pharmacologic and nonpharmacologic treatment options are scarce. Because fatigue in ILD is often a multifactorial problem, therapeutic interventions ideally should be aimed at different domains. One of the first steps is to optimize treatment of the underlying disease. Subsequently, treatable causes of fatigue should be identified and treated. Recently, an increasing number of studies showed that supportive measures have the potential to improve fatigue. However, evidence-based treatment guidelines are lacking, and more research is highly needed in this field. In clinical practice, a comprehensive, multidisciplinary, and individually tailored approach seems best fit to optimize treatment of fatigue in patients with ILD.
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Voortman M, Beekman E, Drent M, Hoitsma E, De Vries J. Determination of the smallest detectable change (SDC) and the minimal important difference (MID) for the Small Fiber Neuropathy Screening List (SFNSL) in sarcoidosis. SARCOIDOSIS VASCULITIS AND DIFFUSE LUNG DISEASES 2020; 35:333-341. [PMID: 32476921 PMCID: PMC7170121 DOI: 10.36141/svdld.v35i4.7260] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Accepted: 08/24/2018] [Indexed: 12/25/2022]
Abstract
Background: Previous studies found that 40-60% of the sarcoidosis patients suffer from small fiber neuropathy (SFN), substantially affecting quality of life. SFN is difficult to diagnose, as a gold standard is still lacking. The need for an easily administered screening instrument to identify sarcoidosis-associated SFN symptoms led to the development of the SFN Screening List (SFNSL). The usefulness of any questionnaire in clinical management and research trials depends on its interpretability. Obtaining a clinically relevant change score on a questionnaire requires that the smallest detectable change (SDC) and minimal important difference (MID) are known. Objectives: The aim of this study was to determine the SDC and MID for the SFNSL in patients with sarcoidosis. Methods: Patients with neurosarcoidosis and/or sarcoidosis-associated SFN symptoms (N=138) included in the online Dutch Neurosarcoidosis Registry participated in a prospective, longitudinal study. Anchor-based and distribution-based methods were used to estimate the MID and SDC, respectively. Results: The SFNSL was completed both at baseline and at 6-months’ follow-up by 89/138 patients. A marginal ROC curve (0.6) indicated cut-off values of 3.5 points, with 73% sensitivity and 49% specificity for change. The SDC was 11.8 points. Conclusions: The MID on the SFNSL is 3.5 points for a clinically relevant change over a 6-month period. The MID can be used in the follow-up and management of SFN-associated symptoms in patients with sarcoidosis, though with some caution as the SDC was found to be higher. (Sarcoidosis Vasc Diffuse Lung Dis 2018; 35: 333-341)
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Affiliation(s)
- Mareye Voortman
- ILD Center of Excellence, Department of Pulmonology, St. Antonius Hospital, Nieuwegein, The Netherlands.,Department of Pulmonology, Division of Heart & Lungs, University Medical Centre Utrecht, The Netherlands.,ild care foundation research team, Ede, The Netherlands
| | - Emmylou Beekman
- Research Centre for Autonomy and Participation of Persons with a Chronic Illness, Zuyd University of Applied Sciences, Heerlen, The Netherlands.,Physiotherapy-multidisciplinary centre, ParaMedisch Centrum Zuid, Sittard, The Netherlands.,Department of Family Medicine, CAPHRI School for Public Health and Primary care, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Marjolein Drent
- ILD Center of Excellence, Department of Pulmonology, St. Antonius Hospital, Nieuwegein, The Netherlands.,Department of Pharmacology and Toxicology, FHML, Maastricht University, Maastricht, The Netherlands.,ild care foundation research team, Ede, The Netherlands
| | - Elske Hoitsma
- Department of Neurology, Alrijne Hospital, Leiden, The Netherlands
| | - Jolanda De Vries
- ild care foundation research team, Ede, The Netherlands.,Department of Medical Psychology, Elisabeth-TweeSteden Hospital Tilburg, Tilburg, The Netherlands.,Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands
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23
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Moor CC, Kahlmann V, Culver DA, Wijsenbeek MS. Comprehensive Care for Patients with Sarcoidosis. J Clin Med 2020; 9:E390. [PMID: 32024123 PMCID: PMC7074229 DOI: 10.3390/jcm9020390] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Revised: 01/21/2020] [Accepted: 01/29/2020] [Indexed: 02/07/2023] Open
Abstract
Sarcoidosis is a multisystem granulomatous disease, associated with significant morbidity and impaired quality of life. Treatment is aimed at recovering organ function, reducing symptom burden and improving quality of life. Because of the heterogeneity and variable disease course, a comprehensive, multidisciplinary approach to care is needed. Comprehensive care includes not only pharmacological interventions, but also supportive measures aimed at relieving symptoms and improving quality of life. The purpose of this review is to summarize the most recent knowledge regarding different aspects of care and propose a structured approach to sarcoidosis management.
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Affiliation(s)
- Catharina C. Moor
- Department of Respiratory Medicine, Erasmus Medical Center Rotterdam, 3015 GD Rotterdam, The Netherlands
| | - Vivienne Kahlmann
- Department of Respiratory Medicine, Erasmus Medical Center Rotterdam, 3015 GD Rotterdam, The Netherlands
| | - Daniel A. Culver
- Department of Pulmonary Medicine, Respiratory Institute, Cleveland Clinic, Cleveland, OH 44195, USA
| | - Marlies S. Wijsenbeek
- Department of Respiratory Medicine, Erasmus Medical Center Rotterdam, 3015 GD Rotterdam, The Netherlands
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24
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Abstract
Introduction: The treatment of pulmonary sarcoidosis is not standardized. Treatment involves a multi-step decision process beginning with whether treatment is warranted, determining initial therapy, then assessing when therapy requires modifications or can be discontinued.Areas covered: This manuscript will address the following issues concerning the treatment of pulmonary sarcoidosis: Treatment indications, initial anti-granulomatous therapy, therapy for chronic and fibrotic disease, glucocorticoid therapy, alternative therapy to glucocorticoids, non-granulomatous therapies, and managing complications of disease. Information was obtained through a literature search of PubMed and Web of Science databases.Expert opinion: Although glucocorticoids are highly effective for pulmonary sarcoidosis, their potential to cause significant side effects often mandates consideration of alternative agents. As the most common indication for the treatment of pulmonary sarcoidosis is quality of life impairment, traditional objective tests of lung function and radiographic imagining often have a minor role in therapeutic decision-making. The development of pulmonary fibrosis from sarcoidosis often causes major morbidity and mortality and should be a major focus of concern.
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Affiliation(s)
- W Ennis James
- Division of Pulmonary and Critical Care Medicine; Program Director, Susan Pearlstine Sarcoidosis Center of Excellence, Medical University of South Carolina, Charleston, SC, USA
| | - Marc A Judson
- Division of Pulmonary and Critical Care Medicine, Albany Medical College MC-91, Albany, NY, USA
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Stern BJ, Royal W, Gelfand JM, Clifford DB, Tavee J, Pawate S, Berger JR, Aksamit AJ, Krumholz A, Pardo CA, Moller DR, Judson MA, Drent M, Baughman RP. Definition and Consensus Diagnostic Criteria for Neurosarcoidosis: From the Neurosarcoidosis Consortium Consensus Group. JAMA Neurol 2019; 75:1546-1553. [PMID: 30167654 DOI: 10.1001/jamaneurol.2018.2295] [Citation(s) in RCA: 197] [Impact Index Per Article: 39.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Importance The Neurosarcoidosis Consortium Consensus Group, an expert panel of physicians experienced in the management of patients with sarcoidosis and neurosarcoidosis, engaged in an iterative process to define neurosarcoidosis and develop a practical diagnostic approach to patients with suspected neurosarcoidosis. This panel aimed to develop a consensus clinical definition of neurosarcoidosis to enhance the clinical care of patients with suspected neurosarcoidosis and to encourage standardization of research initiatives that address this disease. Observations The work of this collaboration included a review of the manifestations of neurosarcoidosis and the establishment of an approach to the diagnosis of this disorder. The proposed consensus diagnostic criteria, which reflect current knowledge, provide definitions for possible, probable, and definite central and peripheral nervous system sarcoidosis. The definitions emphasize the need to evaluate patients with findings suggestive of neurosarcoidosis for alternate causal factors, including infection and malignant neoplasm. Also emphasized is the need for biopsy, whenever feasible and advisable according to clinical context and affected anatomy, of nonneural tissue to document the presence of systemic sarcoidosis and support a diagnosis of probable neurosarcoidosis or of neural tissue to support a diagnosis of definite neurosarcoidosis. Conclusions and Relevance Diverse disease presentations and lack of specificity of relevant diagnostic tests contribute to diagnostic uncertainty. This uncertainty is compounded by the absence of a pathognomonic histologic tissue examination. The diagnostic criteria we propose are designed to focus investigations on NS as accurately as possible, recognizing that multiple pathophysiologic pathways may lead to the clinical manifestations we currently term NS. Research recognizing the clinical heterogeneity of this diagnosis may open the door to identifying meaningful biologic factors that may ultimately contribute to better treatments.
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Affiliation(s)
- Barney J Stern
- Department of Neurology, Johns Hopkins University, Baltimore, Maryland
| | - Walter Royal
- Department of Neurobiology and the Neuroscience Institute, Morehouse School of Medicine, Atlanta, Georgia
| | - Jeffrey M Gelfand
- Department of Neurology, University of California, San Francisco, San Francisco
| | - David B Clifford
- Department of Neurology, Washington University in St Louis, St Louis, Missouri
| | - Jinny Tavee
- Department of Neurology, Northwestern University, Chicago, Illinois
| | - Siddharama Pawate
- Department of Neurology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Joseph R Berger
- Department of Neurology, University of Pennsylvania, Philadelphia
| | | | - Allan Krumholz
- Department of Neurology, University of Maryland, Baltimore
| | - Carlos A Pardo
- Department of Neurology, Johns Hopkins University, Baltimore, Maryland
| | - David R Moller
- Department of Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Marc A Judson
- Department of Medicine, Albany Medical College, Albany, New York
| | - Marjolein Drent
- Department of Pharmacology and Toxicology, Faculty of Health Medicine and Life Sciences, Maastricht University, Maastricht, Interstitial Lung Disease Center of Excellence, St. Antonius Hospital, Nieuwegein, the Netherlands
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Abstract
PURPOSE OF REVIEW The current review discusses the diagnosis and management of nonorgan-related symptoms that commonly arise in the setting of systemic sarcoidosis. Fatigue, small fiber neuropathy (SFN) and neuropsychological symptoms are highlighted. RECENT FINDINGS The debilitating effects of chronic nonorgan-based symptoms in sarcoidosis have led to recent studies focusing on incidence rates, contributing factors and potential therapeutic strategies. In a web-based survey of over 1000 sarcoidosis patients, the most common symptom was fatigue, which was reported by over 90% of participants, whereas memory loss and concentration problems were reported in 50%. SFN was also common, and may be diagnosed with tools such as skin biopsy measurement of intraepidermal nerve fibers and corneal confocal microscopy. In a recent cohort study of SFN patients, serologic evaluation demonstrated other contributing causes such as diabetes and vitamin B12 deficiency, which warrant-specific treatment. Finally, physical inactivity in patients with sarcoidosis correlated with lower quality-of-life (QOL) scores and possibly fatigue. Multidisciplinary programs that include physical therapy, patient education and psychological support were found to improve fatigue and mood disorders. SUMMARY Recognition of nonorgan-related symptoms and their impact on patient QOL is essential to optimal treatment of the sarcoidosis patient.
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Affiliation(s)
- Jinny Tavee
- Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL
- Department of Pulmonary Medicine, Cleveland Clinic Foundation, Cleveland OH
| | - Daniel Culver
- Sarcoidosis Center, Cleveland Clinic Foundation, Cleveland, Ohio, USA
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Voortman M, Hendriks CMR, Lodder P, Drent M, De Vries J. Quality of Life of Couples Living with Sarcoidosis. Respiration 2019; 98:373-382. [PMID: 31437834 PMCID: PMC6888889 DOI: 10.1159/000501657] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Accepted: 06/20/2019] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Consequences of sarcoidosis are wide ranging, and the symptom burden has a great impact on patients' quality of life (QoL). However, the QoL of couples living with sarcoidosis has not yet been studied. OBJECTIVES Our aim was to assess the QoL of couples living with sarcoidosis and to evaluate whether living with a partner with sarcoidosis influences the partner's QoL. Furthermore, we aimed to assess whether nonspecific symptoms (fatigue, cognitive failure, small fiber neuropathy (SFN)-related symptoms, depressive symptoms, and state/trait anxiety) predict QoL of partners as well as sarcoidosis patients. METHOD Sarcoidosis outpatients, recruited at Maastricht University Medical Centre (n = 443), and their partners (n = 208) completed several questionnaires, including the World Health Organization QoL - BREF, Fatigue Assessment Scale, SFN screening list, and cognitive failure questionnaire. RESULTS QoL of the partners as well as the sarcoidosis patients was reduced compared with healthy controls, especially regarding the physical health domain. All nonspecific symptoms studied, as well as perceived social support, predicted one or more QoL domains in the sarcoidosis patients, but these factors did not predict the QoL of their partners. CONCLUSIONS The QoL of partners of sarcoidosis patients was reduced, although to a lesser extent than that of the patients. Although the nonspecific symptoms and perceived social support were related to the patients' QoL, this was not the case for the partners. In the management of sarcoidosis, it is important to focus not only on the patients but also on their partners.
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Affiliation(s)
- Mareye Voortman
- Department of Pulmonology, ILD Center of Excellence, St. Antonius Hospital, Nieuwegein, The Netherlands,
- Department of Pulmonology, Division of Heart and Lungs, University Medical Centre Utrecht, Utrecht, The Netherlands,
- Mild care foundation research team, Ede, The Netherlands,
| | - Celine M R Hendriks
- Mild care foundation research team, Ede, The Netherlands
- Faculty of Medicine, Utrecht University, Utrecht, The Netherlands
| | - Paul Lodder
- Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands
- Department of Methodology and Statistics, Tilburg University, Tilburg, The Netherlands
| | - Marjolein Drent
- Department of Pulmonology, ILD Center of Excellence, St. Antonius Hospital, Nieuwegein, The Netherlands
- Mild care foundation research team, Ede, The Netherlands
- Department of Pharmacology and Toxicology, FHML, Maastricht University, Maastricht, The Netherlands
| | - Jolanda De Vries
- Mild care foundation research team, Ede, The Netherlands
- Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands
- Department of Medical Psychology, ETZ (Elisabeth-TweeSteden Ziekenhuis) Tilburg, Tilburg, The Netherlands
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28
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Abstract
PURPOSE OF REVIEW Sarcoidosis is a complex disease with many faces, and the clinical manifestation and course of neurosarcoidosis are particularly variable. Although neurosarcoidosis occurs in up to 10% of sarcoidosis patients, it can lead to significant morbidity and some mortality. RECENT FINDINGS Three criteria are usually required for a diagnosis of (neuro)sarcoidosis: clinical and radiologic manifestations, noncaseating granulomas, and no evidence of alternative disease. Recent guidelines have helped to clarify criteria for diagnosing neurosarcoidosis. No firm guidelines exist on whether, when, and how treatment should be started. Treatment depends on the presentation and distribution, extensiveness, and severity of neurosarcoidosis. As regards evidence-based treatment, only a few randomized controlled trials have been done. Hence, several aspects of (neuro)sarcoidosis management are not fully addressed by the current literature. SUMMARY Significant advances have been made in the potential and accuracy of diagnostics for neurosarcoidosis. Treatment should be approached within the context of the patient's anticipated clinical course, avoidance of adverse drug effects, and, if necessary, from the perspective of the comprehensive management of a chronic disease. A multidisciplinary approach to the management of sarcoidosis is strongly recommended.
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Affiliation(s)
- Mareye Voortman
- ILD Center of Excellence, Department of Pulmonology, St. Antonius Hospital, Nieuwegein
- Department of Pulmonology, Division of Heart & Lungs, University Medical Centre Utrecht, Utrecht
- ild care foundation research team, Ede
| | - Marjolein Drent
- ILD Center of Excellence, Department of Pulmonology, St. Antonius Hospital, Nieuwegein
- ild care foundation research team, Ede
- Department of Pharmacology and Toxicology, FHML, Maastricht University, Maastricht, The Netherlands
| | - Robert P. Baughman
- Department of Medicine, University of Cincinnati Medical Center, Cincinnati, Ohio, USA
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29
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The Fatigue Assessment Scale: quality and availability in sarcoidosis and other diseases. Curr Opin Pulm Med 2019; 24:495-503. [PMID: 29889115 DOI: 10.1097/mcp.0000000000000496] [Citation(s) in RCA: 58] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
PURPOSE OF REVIEW Fatigue is a problem experienced by many patients suffering from chronic diseases, including sarcoidosis patients. It has a substantial influence on patients' quality of life (QoL). It is, therefore, important to properly assess fatigue with a valid and reliable measure. The Fatigue Assessment Scale (FAS) is the only validated self-reporting instrument classifying fatigue in sarcoidosis. The aim of this review was to examine the psychometric properties of the FAS and the diseases and languages in which it has been used. Studies among sarcoidosis patients were also reviewed in terms of outcomes. RECENT FINDINGS Studies were identified by searching the electronic bibliographic database Pubmed. Search terms used were: FAS and fatigue. Articles were included in the review if the FAS had been used to assess fatigue. RESULTS Since its introduction, the FAS was used in 26 different diseases or conditions, including stroke, neurologic disorders, rheumatoid arthritis, idiopathic pulmonary fibrosis and sarcoidosis. Its reliability and validity have proved to be good. Unidimensionality has been established. So far, the FAS is available in 20 languages and widely used in sarcoidosis. Digital versions as well as PDFs of various languages are available online (www.wasog.org). SUMMARY The FAS has good psychometric qualities for the diseases in which it has been examined, including sarcoidosis, and can be used in clinical practice. Healthcare workers can use the FAS to assess fatigue in the management, follow-up and clinical care programmes for their patients consistently across countries, as well as in clinical research.
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30
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Sarcoidosis and Work Participation: The Need to Develop a Disease-Specific Core Set for Assessment of Work Ability. Lung 2019; 197:407-413. [PMID: 31101981 PMCID: PMC6647075 DOI: 10.1007/s00408-019-00234-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Accepted: 04/30/2019] [Indexed: 12/12/2022]
Abstract
Objective Sarcoidosis, an inflammatory multi-organ disease with a wide variety of clinical manifestations, affecting people of working age. Patients suffer from a broad spectrum of physical symptoms of varying severity that impact function including cognitive impairment and disabling fatigue. The Dutch Sarcoidosis Society identified a knowledge gap in various facets related to work ability. The aim of this study was to assess sarcoidosis patients’ perceived problems related to work performance, employer, and disability evaluations. Methods A cross-sectional web-based anonymous survey was conducted among Dutch sarcoidosis patients recruited through sarcoidosis patient societies and outpatient sarcoidosis clinics. This investigation queried work performance, employer support, and disability evaluations. Results The study sample included 755 patients of whom 43% (n = 328) had undergone disability evaluation and were significantly more likely to experience extrapulmonary symptoms, severe fatigue, reduced exercise capacity along with memory problems and concentration problems with higher mean FAS and SFNSL-scores. Of these 328, 37% (n = 121) perceived they had not been listened to or taken seriously at assessments, and 38% (n = 124) disagreed with the outcome of disability assessments by benefits authorities; 75% (n = 93) appealed or requested re-assessment. Discussion A better understanding of sarcoidosis-related impact on work ability and quantification of disease burden is needed. Education for medical examiners and employers on sarcoidosis may improve quality of assessments and work accommodations. Development of guidelines for benefit authorities, which consider the broad impact of sarcoidosis beyond that of reduced pulmonary function, including extra-pulmonary assessment like fatigue, cognitive difficulties, as well as other organ involvement are needed.
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31
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Voortman M, De Vries J, Hendriks CMR, Elfferich MDP, Wijnen PAHM, Drent M. Everyday cognitive failure in patients suffering from neurosarcoidosis. SARCOIDOSIS VASCULITIS AND DIFFUSE LUNG DISEASES 2019; 36:2-10. [PMID: 32476930 DOI: 10.36141/svdld.v36i1.7412] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Accepted: 11/14/2018] [Indexed: 11/02/2022]
Abstract
Background Cognitive failure is associated with memory and concentration problems. Previously, a prevalence of one third was found in a general sarcoidosis population. The aim of this study was to assess if neurosarcoidosis patients are at higher risk for developing everyday cognitive failure using the Cognitive Failure Questionnaire (CFQ) and to determine what factors were associated with cognitive failure. Methods A cross-sectional web-based survey was conducted from April to May 2017 in a national sample of neurosarcoidosis patients. The survey asked about complaints and included 3 questionnaires (Fatigue Assessment Scale [FAS], Small Fiber Neuropathy Screening List [SFNSL] and CFQ. Data were compared to a general sarcoidosis population. Results Of the 152 patients who completed the survey, 131 had neurosarcoidosis. The mean CFQ score was significantly higher in the neurosarcoidosis (45.6±20.7) compared to the general sarcoidosis population (36.2±15.9; p< 0.0001). High CFQ scores (≥43) were found in 55.7% and 33.9%, respectively (p<0.0001). The FAS score (OR 21.4) and SFNSL score (OR 4.3) were the strongest positive predictors of a high CFQ score. Conclusion Cognitive failure is a significant problem in neurosarcoidosis. More than half of the patients reported cognitive deficits, compared to one third of a general sarcoidosis population. Fatigue and small fiber neuropathy play a role in cognitive failure.
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Affiliation(s)
- Mareye Voortman
- ILD Center of Excellence, Department of Pulmonology, St. Antonius Hospital, Nieuwegein, The Netherlands.,Department of Pulmonology, Division of Heart & Lungs, University Medical Centre Utrecht, The Netherlands.,ild care foundation research team, Ede, The Netherlands
| | - Jolanda De Vries
- ild care foundation research team, Ede, The Netherlands.,Department of Medical Psychology, Elisabeth-TweeSteden Hospital Tilburg, Tilburg, The Netherlands.,Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands
| | - Celine M R Hendriks
- ILD Center of Excellence, Department of Pulmonology, St. Antonius Hospital, Nieuwegein, The Netherlands.,ild care foundation research team, Ede, The Netherlands
| | | | - Petal A H M Wijnen
- ild care foundation research team, Ede, The Netherlands.,Central Diagnostic Laboratory, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Marjolein Drent
- ILD Center of Excellence, Department of Pulmonology, St. Antonius Hospital, Nieuwegein, The Netherlands.,ild care foundation research team, Ede, The Netherlands.,Department of Pharmacology and Toxicology, FHML, Maastricht University, Maastricht, The Netherlands
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32
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Voortman M, Hendriks CMR, Elfferich MDP, Bonella F, Møller J, De Vries J, Costabel U, Drent M. The Burden of Sarcoidosis Symptoms from a Patient Perspective. Lung 2019; 197:155-161. [PMID: 30778661 PMCID: PMC6486948 DOI: 10.1007/s00408-019-00206-7] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Accepted: 02/07/2019] [Indexed: 12/19/2022]
Abstract
PURPOSE The clinical manifestations of sarcoidosis vary widely, depending on the intensity of the inflammation and the organ systems affected. Hence, sarcoidosis patients may suffer from a great variety of symptoms. The aim of this study was to compare the self-reported burden of sarcoidosis patients in Denmark, Germany and the Netherlands, especially the prevalence of fatigue and small fiber neuropathy (SFN)-related symptoms, as well as differences in treatment strategies. METHODS A cross-sectional web-based anonymous survey about complaints was conducted among sarcoidosis patients. Patients were invited to take part through the sarcoidosis patient societies as well as through outpatient sarcoidosis clinics in these countries. RESULTS The questionnaire was completed by 1072 sarcoidosis patients (152 Danish, 532 German and 388 Dutch). Almost all patients reported having sarcoidosis-associated symptoms (organ-related as well as non-specific, non-organ related). Fatigue was reported by almost all respondents (90%), followed by pulmonary symptoms (72.4%). More than 50% of the respondents were being treated with prednisone, which was comparable in all three countries. In contrast, second- and third-line treatment differed substantially between Denmark, Germany and the Netherlands. CONCLUSION Sarcoidosis patients in Denmark, Germany and the Netherlands present with similar self-reported symptoms, organ-related as well as non-specific, non-organ related. Fatigue (90%) and symptoms associated with SFN (86%) were highly prevalent in all three countries.
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Affiliation(s)
- M Voortman
- ILD Center of Excellence, Department of Pulmonology, St. Antonius Hospital, PO Box 2400, 3430 VB, Nieuwegein, The Netherlands. .,Department of Pulmonology, Division of Heart & Lungs, University Medical Centre Utrecht, Utrecht, The Netherlands. .,ILD Care Foundation Research Team, Ede, The Netherlands.
| | - C M R Hendriks
- ILD Center of Excellence, Department of Pulmonology, St. Antonius Hospital, PO Box 2400, 3430 VB, Nieuwegein, The Netherlands.,ILD Care Foundation Research Team, Ede, The Netherlands.,Faculty of Medicine, Utrecht University, Utrecht, The Netherlands
| | | | - F Bonella
- Interstitial and Rare Lung Disease Unit, Ruhrlandklinik, University Hospital, Essen, Germany
| | - J Møller
- Department of Respiratory Diseases and Allergology, Aarhus University Hospital, Aarhus, Denmark
| | - J De Vries
- Department of Medical Psychology, Elisabeth-TweeSteden Hospital Tilburg, Tilburg, The Netherlands.,Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands
| | - U Costabel
- Interstitial and Rare Lung Disease Unit, Ruhrlandklinik, University Hospital, Essen, Germany
| | - M Drent
- ILD Center of Excellence, Department of Pulmonology, St. Antonius Hospital, PO Box 2400, 3430 VB, Nieuwegein, The Netherlands.,ILD Care Foundation Research Team, Ede, The Netherlands.,Department of Pharmacology and Toxicology, FHML, Maastricht University, Maastricht, The Netherlands
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33
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Baughman RP, Barriuso R, Beyer K, Boyd J, Hochreiter J, Knoet C, Martone F, Quadder B, Richardson J, Spitzer G, Valeyre D, Ziosi G. Sarcoidosis: patient treatment priorities. ERJ Open Res 2018; 4:00141-2018. [PMID: 30588477 PMCID: PMC6302206 DOI: 10.1183/23120541.00141-2018] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Accepted: 11/06/2018] [Indexed: 02/07/2023] Open
Abstract
Sarcoidosis patient survey reveals QoL and functionality are required as core outcomes in treatment and care, along with more multidisciplinary working by clinicians and the establishment of specialist sarcoidosis centres in every European country http://ow.ly/DTvt30mQnqc.
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Affiliation(s)
| | - Rita Barriuso
- Asociación Nacional de Enfermos de Sarcoidosis, Madrid, Spain
| | - Kelli Beyer
- Foundation for Sarcoidosis Research, Chicago, IL, USA
| | | | | | - Chris Knoet
- Sarcoïdose Belangenvereniging Nederland (SBN), Valkenburg, The Netherlands
| | | | - Bernd Quadder
- Deutsche Sarkoidose-Vereinigung e.V. (DSV), Health Policy and Sarcoidosis Research, Meerbusch, Germany
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34
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Gruet M. Fatigue in Chronic Respiratory Diseases: Theoretical Framework and Implications For Real-Life Performance and Rehabilitation. Front Physiol 2018; 9:1285. [PMID: 30283347 PMCID: PMC6156387 DOI: 10.3389/fphys.2018.01285] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2018] [Accepted: 08/27/2018] [Indexed: 12/13/2022] Open
Abstract
Fatigue is a primary disabling symptom in chronic respiratory diseases (CRD) with major clinical implications. However, fatigue is not yet sufficiently explored and is still poorly understood in CRD, making this symptom underdiagnosed and undertreated in these populations. Fatigue is a dynamic phenomenon, particularly in such evolving diseases punctuated by acute events which can, alone or in combination, modulate the degree of fatigue experienced by the patients. This review supports a comprehensive inter-disciplinary approach of CRD-related fatigue and emphasizes the need to consider both its performance and perceived components. Most studies in CRD evaluated perceived fatigue as a trait characteristic using multidimensional scales, providing precious information about its prevalence and clinical impact. However, these scales are not adapted to understand the complex dynamics of fatigue in real-life settings and should be augmented with ecological assessment of fatigue. The state level of fatigue must also be considered during physical tasks as severe fatigue can emerge rapidly during exercise. CRD patients exhibit alterations in both peripheral and central nervous systems and these abnormalities can be exacerbated during exercise. Laboratory tests are necessary to provide mechanistic insights into how and why fatigue develops during exercise in CRD. A better knowledge of the neurophysiological mechanisms underlying perceived and performance fatigability and their influence on real-life performance will enable the development of new individualized countermeasures. This review aims first to shed light on the terminology of fatigue and then critically considers the contemporary models of fatigue and their relevance in the particular context of CRD. This article then briefly reports the prevalence and clinical consequences of fatigue in CRD and discusses the strengths and weaknesses of various fatigue scales. This review also provides several arguments to select the ideal test of performance fatigability in CRD and to translate the mechanistic laboratory findings into the clinical practice and real-world performance. Finally, this article discusses the dose-response relationship to training and the feasibility and validity of using the fatigue produced during exercise training sessions in CRD to optimize exercise training efficiency. Methodological concerns, examples of applications in selected diseases and avenues for future research are also provided.
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