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Smedslund G, Kotar AM, Uhlig T. Sarcoidosis with musculoskeletal manifestations: systematic review of non-pharmacological and pharmacological treatments. Rheumatol Int 2022; 42:2109-2124. [PMID: 35943526 PMCID: PMC9548475 DOI: 10.1007/s00296-022-05171-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 07/04/2022] [Indexed: 11/29/2022]
Abstract
We aimed to summarise effects and use of non-pharmacological and pharmacological treatments for sarcoidosis with musculoskeletal manifestations. We systematically searched the Cochrane Library, Ovid MEDLINE, Embase, CINAHL, AMED, Scopus, clinical.trials.gov, PROSPERO and PEDro for systematic reviews from 2014 to 2022 and for primary studies from date of inception to March 29, 2022, and studies with patients diagnosed with sarcoidosis with musculoskeletal manifestations. Inclusion criteria required that studies reported effects of non-pharmacological and/or pharmacological treatments or number of patients receiving these treatments. Results were reported narratively and in forest plots. Eleven studies were included. No systematic reviews fulfilled our inclusion criteria. None of the included studies had a control group. We found that between 23 and 100% received corticosteroids, 0-100% received NSAIDs, 5-100% received hydroxychloroquine, 12-100% received methotrexate, 0-100% received TNF inhibitors, and 3-4% received azathioprine. Only ten patients in one study had used non-pharmacological treatments, including occupational therapy, chiropractic and acupuncture. There are no controlled studies on treatment effects for patients with sarcoidosis with musculoskeletal manifestations. We found 11 studies reporting use of pharmacological treatments and only one study reporting use of non-pharmacological treatments. Our study identified major research gaps for pharmacological and non-pharmacological treatment in musculoskeletal sarcoidosis and warrant randomised clinical trials for both.
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Affiliation(s)
- Geir Smedslund
- Division of Rheumatology and Research, Diakonhjemmet Hospital, Norwegian National Advisory Unit On Rehabilitation in Rheumatology, Oslo, Norway.
| | - Annie Martina Kotar
- Division of Rheumatology and Research, Diakonhjemmet Hospital, Norwegian National Advisory Unit On Rehabilitation in Rheumatology, Oslo, Norway
| | - Till Uhlig
- Division of Rheumatology and Research, Diakonhjemmet Hospital, Norwegian National Advisory Unit On Rehabilitation in Rheumatology, Oslo, Norway
- University of Oslo, Oslo, Norway
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Mahalwar G, Kumar A, Agrawal A, Bhat A, Furqan M, Yesilyaprak A, Verma BR, Chan N, Schleicher M, Neto MLR, Xu B, Jellis CL, Klein AL. Pericardial Involvement in Sarcoidosis. Am J Cardiol 2022; 170:100-104. [PMID: 35227500 DOI: 10.1016/j.amjcard.2022.01.025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 01/10/2022] [Accepted: 01/20/2022] [Indexed: 12/20/2022]
Abstract
Pericardial disease secondary to sarcoidosis is a rare clinical entity with no observational studies in previous research. Therefore, we evaluated reported cases of pericarditis because of sarcoidosis to further understand its diagnosis and management. We performed a systematic review of previous research until December 16, 2020 in MEDLINE, Embase, Scopus, Cochrane Central Register of Controlled Trials, and Web of Science. Case reports and case series demonstrating pericardial involvement in sarcoidosis were included. Fourteen reports with a total of 27 patients were identified. Dyspnea (82%) was the most common presentation, with the lungs being the primary site of sarcoidosis in most patients (77%). The most frequently encountered pericardial manifestations were pericardial effusion (89%), constrictive pericarditis and cardiac tamponade (48%). Management of these patients included use of corticosteroids (82%), colchicine (11%), and nonsteroidal anti-inflammatory agents (7%). Similar to the general population, the most common intervention in these patients was pericardiocentesis (59%), pericardial window (30%), and pericardiectomy (19%). Overall, the majority of this population (70%) achieved clinical improvement during median follow-up time of 8 months. In conclusion, the prevalence and incidence of sarcoid-induced pericarditial disease remain unclear. Clinical manifestations of pericardial involvement are variable, though many patients present with asymptomatic pericardial effusions. No consensus exists on the treatment of this special population, but corticosteroids and combination therapies are considered first-line therapies because of their efficacy in suppressing pericardial inflammation and underlying sarcoidosis. Patients with refractory cases of pericarditis may also benefit therapeutically from the addition of nonsteroidal anti-inflammatory agents, colchicine, and/or biologics.
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Abstract
PURPOSE OF REVIEW The aim of this article is to describe the known health disparities that exist among patients with sarcoidosis by socioeconomic status, race, and gender, review potential contributors to health disparities in sarcoidosis, investigate the intersectionality among socioeconomic status, race, and gender in sarcoidosis, and outline a research agenda to address these disparities. RECENT FINDINGS Recent studies have reported the significant financial strain a diagnosis of sarcoidosis has on individuals and the disproportionate affect the strain has on low socioeconomic status individuals, Blacks, and females. Worse dyspnea, lower health-related quality of life, and higher rates of mortality and hospitalization are more common among those who are Black, female, or of low socioeconomic status. SUMMARY Health disparities in sarcoidosis by socioeconomic status, race, and gender have been described for decades. In this review, we describe potential contributors to health disparities including stress and propose interventions to address disparities including creating educational programs accessible for low-income patients and caregivers, targeting medication adherence and trust in physicians and the medical system, and ensuring access to high-quality care for all patients. As clinicians and researchers, we owe it to our patients to not only describe the health disparities that exist but also stimulate to achieve improvement in sarcoidosis.
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Ulcerative cutaneous sarcoidosis successfully treated with infliximab. Clin Rheumatol 2021; 40:4349-4354. [PMID: 33728543 DOI: 10.1007/s10067-021-05689-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2020] [Revised: 02/21/2021] [Accepted: 03/09/2021] [Indexed: 12/23/2022]
Abstract
Sarcoidosis is a systemic inflammatory disorder with cutaneous involvement present in 25% of cases. We present a patient with ulcerative sarcoidosis to highlight this unusual presentation of a relatively rare cutaneous condition that was treated successfully using infliximab. The drug is effective in cutaneous sarcoidosis, but relapses can occur after discontinuation. In this article, we reviewed the clinical features and therapeutic modalities for ulcerative cutaneous sarcoidosis.
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Stellmacher F, Perner S. [Overview: granulomatous diseases of the lung]. DER PATHOLOGE 2021; 42:64-70. [PMID: 33475808 DOI: 10.1007/s00292-020-00893-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/15/2020] [Indexed: 11/26/2022]
Abstract
The spectrum of pulmonary granulomatoses is wide and includes infectious and noninfectious entities, each with very different therapeutic consequences. The first step of histological examination discriminates between necrotizing and non-necrotizing granulomatosis. After this, an infectious cause of the granulomatosis has to be excluded by special histological stains and molecular-pathologic methods, if necessary. Diagnosis also includes clinical, radiological, and microbiological findings. The process of pathological examination should be standardized as described.
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Affiliation(s)
- Florian Stellmacher
- Pathologie, Forschungszentrum Borstel, Leibniz Lungenzentrum, Parkallee 1-40, 23845, Borstel, Deutschland.
| | - Sven Perner
- Pathologie, Forschungszentrum Borstel, Leibniz Lungenzentrum, Parkallee 1-40, 23845, Borstel, Deutschland
- Institut für Pathologie, Universität zu Lübeck, Universitätsklinikum Schleswig-Holstein, Lübeck, Deutschland
- Airwary Research Center North (ARCN), Deutsches Zentrum für Lungenforschung (DZL), Gießen, Deutschland
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Abstract
Sarcoidosis is a systemic disease of unknown etiology defined by the presence of noncaseating granulomatous inflammation that can cause organ damage and diminished quality of life. Treatment is indicated to protect organ function and decrease symptomatic burden. Current treatment options focus on interruption of granuloma formation and propagation. Clinical trials guiding evidence for treatment are lacking due to the rarity of disease, heterogeneous clinical course, and lack of prognostic biomarkers, all of which contribute to difficulty in clinical trial design and implementation. In this review, a multidisciplinary treatment approach is summarized, addressing immunuosuppressive drugs, managing complications of chronic granulomatous inflammation, and assessing treatment toxicity. Discovery of new therapies will depend on research into pathogenesis of antigen presentation and granulomatous inflammation. Future treatment approaches may also include personalized decisions based on pharmacogenomics and sarcoidosis phenotype, as well as patient-centered approaches to manage immunosuppression, symptom control, and treatment of comorbid conditions.
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Affiliation(s)
- Alicia K. Gerke
- Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Iowa, Iowa City, IA, United States
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Papiris SA, Manali ED, Papaioannou AI, Georgakopoulos A, Kolilekas L, Pianou NK, Kallergi M, Papaporfyriou A, Kallieri M, Apollonatou V, Papadaki G, Malagari K, Kelekis NL, Pneumatikos SG, Chatziioannou S. Prevalence, distribution and clinical significance of joints, muscles and bones in sarcoidosis: an 18F-FDG-PET/CT study. Expert Rev Respir Med 2020; 14:957-964. [PMID: 32460642 DOI: 10.1080/17476348.2020.1775587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
OBJECTIVES In Sarcoidosis joints-muscles-bones (JMBs) localizations are of the least common. 18F-FDG-PET/CT imaging revolutionized detection of JMBs involvement by adding metabolic activity information and allowing for a comprehensive, whole-body mapping of the disease. AIM AND METHODS This study investigated prevalence, distribution, and clinical significance of JMBs sarcoidosis in 195 consecutive patients that underwent 18F-FDG PET/CT examination. RESULTS Joint and bone involvement were encountered in 15% of patients with a mean of the maximum-standardized-uptake-value (SUVmax) of 6.1. Most common location was the axial skeleton. Hypercalciuria was significantly more frequent in patients with osseous involvement (p = 0.003). Muscle activity (SUVmax = 2.4) was encountered in 20% of the patients, most frequently in treatment-naïve (p = 0.02). The muscles of the lower extremities were affected the most. Muscle and bone localization coexist in 50% of the cases. JMBs disease was almost asymptomatic, not related to chronicity but to pulmonary, nodal, and systemic disease. Long-term follow-up and treatment response of affected patients confirmed sarcoidosis. CONCLUSION 18F-FDG-PET/CT revealed JMBs localizations and coexistence with other organ sites supporting the concept that sarcoidosis is a systemic disease. By allowing an integrative interpretation of multi-organ involvement in the context of a pattern highly suggestive of sarcoidosis, it strongly keeps-off the diagnosis of malignancy.
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Affiliation(s)
- Spyros A Papiris
- 2nd Pulmonary Medicine Department, General University Hospital "Attikon", Medical School, National and Kapodistrian University of Athens , Athens, Greece
| | - Effrosyni D Manali
- 2nd Pulmonary Medicine Department, General University Hospital "Attikon", Medical School, National and Kapodistrian University of Athens , Athens, Greece
| | - Andriana I Papaioannou
- 2nd Pulmonary Medicine Department, General University Hospital "Attikon", Medical School, National and Kapodistrian University of Athens , Athens, Greece
| | - Alexandros Georgakopoulos
- 2nd Department of Radiology, Division of Nuclear Medicine, General University Hospital "Attikon", Medical School, National and Kapodistrian University of Athens , Athens, Greece.,Nuclear Medicine Division, Biomedical Research Foundation of the Academy of Athens , Athens, Greece
| | | | - Nikoletta K Pianou
- Nuclear Medicine Division, Biomedical Research Foundation of the Academy of Athens , Athens, Greece.,Departments of Nuclear Medicine, Evangelismos General Hospital , Athens, Greece
| | - Maria Kallergi
- Nuclear Medicine Division, Biomedical Research Foundation of the Academy of Athens , Athens, Greece.,Department of Biomedical Engineering, University of West Attika , Athens, Greece
| | - Anastasia Papaporfyriou
- 2nd Pulmonary Medicine Department, General University Hospital "Attikon", Medical School, National and Kapodistrian University of Athens , Athens, Greece
| | - Maria Kallieri
- 2nd Pulmonary Medicine Department, General University Hospital "Attikon", Medical School, National and Kapodistrian University of Athens , Athens, Greece
| | - Vasiliki Apollonatou
- 2nd Pulmonary Medicine Department, General University Hospital "Attikon", Medical School, National and Kapodistrian University of Athens , Athens, Greece
| | - Georgia Papadaki
- 2nd Pulmonary Medicine Department, General University Hospital "Attikon", Medical School, National and Kapodistrian University of Athens , Athens, Greece
| | - Katerina Malagari
- 2nd Department of Radiology, General University Hospital "Attikon", Medical School, National and Kapodistrian University of Athens , Athens, Greece
| | - Nikolaos L Kelekis
- 2nd Department of Radiology, General University Hospital "Attikon", Medical School, National and Kapodistrian University of Athens , Athens, Greece
| | - Spyros G Pneumatikos
- 3rd Orthopaedic Department, KAT General Hospital, Medical School, National and Kapodistrian University of Athens , Athens, Greece
| | - Sofia Chatziioannou
- 2nd Department of Radiology, Division of Nuclear Medicine, General University Hospital "Attikon", Medical School, National and Kapodistrian University of Athens , Athens, Greece.,Nuclear Medicine Division, Biomedical Research Foundation of the Academy of Athens , Athens, Greece
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Owen CI, Jabeen F, Bhattacharjee A. Application of the modified Zajicek criteria to diagnose probable spinal cord neurosarcoidosis. Clin Case Rep 2018; 6:1718-1722. [PMID: 30214749 PMCID: PMC6132158 DOI: 10.1002/ccr3.1712] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Accepted: 06/21/2018] [Indexed: 12/22/2022] Open
Abstract
Neurosarcoidosis represents a significant diagnostic challenge, as clinical features overlap with other neuroinflammatory conditions, and biopsy of affected neuronal tissue is often high risk or not feasible. Here we highlight application of the modified Zajicek criteria to diagnose probable spinal neurosarcoidosis in the absence of histology from affected neuronal tissue.
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Martusewicz‐Boros MM, Boros PW, Wiatr E, Fijołek J, Roszkowski‐Śliż K. Systemic treatment for sarcoidosis was needed for 16% of 1810 Caucasian patients. CLINICAL RESPIRATORY JOURNAL 2017; 12:1367-1371. [DOI: 10.1111/crj.12664] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Accepted: 07/09/2017] [Indexed: 11/30/2022]
Affiliation(s)
| | - Piotr W. Boros
- Lung Pathophysiology DepartmentNational TB & Lung Diseases Research InstituteWarsaw 01‐138 Poland
| | - Elżbieta Wiatr
- 3rd Lung Diseases DepartmentNational TB & Lung Diseases Research InstituteWarsaw 01‐138 Poland
| | - Justyna Fijołek
- 3rd Lung Diseases DepartmentNational TB & Lung Diseases Research InstituteWarsaw 01‐138 Poland
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Casanova N, Zhou T, Knox KS, Garcia JGN. Identifying Novel Biomarkers in Sarcoidosis Using Genome-Based Approaches. Clin Chest Med 2015; 36:621-630. [PMID: 26593137 DOI: 10.1016/j.ccm.2015.08.005] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
This article briefly reviews conventional biomarkers used clinically to (1) support a diagnosis and (2) monitor disease progression in patients with sarcoidosis. Potential new biomarkers identified by genome-wide screening and the approaches to discover these biomarkers are described.
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Affiliation(s)
- Nancy Casanova
- University of Arizona Health Sciences Center, Arizona Respiratory Center and Department of Medicine, University of Arizona, Tucson, AZ 78721, USA
| | - Tong Zhou
- University of Arizona Health Sciences Center, Arizona Respiratory Center and Department of Medicine, University of Arizona, Tucson, AZ 78721, USA
| | - Kenneth S Knox
- University of Arizona Health Sciences Center, Arizona Respiratory Center and Department of Medicine, University of Arizona, Tucson, AZ 78721, USA
| | - Joe G N Garcia
- University of Arizona Health Sciences Center, Arizona Respiratory Center and Department of Medicine, University of Arizona, Tucson, AZ 78721, USA
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Crommelin HA, Vorselaars ADM, van Moorsel CHM, Korenromp IHE, Deneer VHM, Grutters JC. Anti-TNF therapeutics for the treatment of sarcoidosis. Immunotherapy 2015; 6:1127-43. [PMID: 25428650 DOI: 10.2217/imt.14.65] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Sarcoidosis is a systemic disease with an incidence of 1 to 40 per 100 000 persons per year. It predominantly affects people in the age of 20 to 40 years old. Disease course varies from mild self-limiting to chronic debilitating and life-threatening disease. Since the cause of sarcoidosis is unknown, curative therapy is not available. Immunosuppressive drugs may, however, control the symptoms of the disease. The hallmark of sarcoidosis is the formation of granulomas that are most commonly found in lungs and lymph nodes. As TNF plays an important role in both formation and maintenance of these granulomas, as well as in the immune response, anti-TNF biologicals such as infliximab and adalimumab are considered a last resort therapeutic option. Clinical effectiveness, however, varies considerably and data showing which patients would benefit most from this expensive therapy are scarce. This review summarizes current knowledge on anti-TNF therapeutics in sarcoidosis, and describes insights on prediction of response, outcome measures and antibody development.
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Affiliation(s)
- Heleen A Crommelin
- Centre of Interstitial Lung Diseases, Department of Pulmonology, St Antonius Hospital, Nieuwegein, The Netherlands
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