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Bert A, El Jammal T, Kodjikian L, Gerfaud-Valentin M, Jamilloux Y, Seve P. Hydroxychloroquine Therapy in Sarcoidosis-Associated Uveitis. Ocul Immunol Inflamm 2024; 32:154-160. [PMID: 36749910 DOI: 10.1080/09273948.2023.2165952] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 01/03/2023] [Indexed: 02/09/2023]
Abstract
BACKGROUND/PURPOSE To assess the efficacy and tolerance of hydroxychloroquine in sarcoidosis-associated uveitis. METHODS Retrospective study on all patients with sarcoidosis-associated uveitis who were treated with hydroxychloroquine between 2003 and 2019 in a French university hospital. RESULTS Twenty-seven patients with sarcoidosis-associated uveitis received hydroxychloroquine. The mean duration of treatment was 20.0 ± 10.9 months. At the end of the follow-up, hydroxychloroquine success was achieved in 15 (55.6%) patients. Four of them were also on oral corticosteroids, with a prednisone dose ≤5 mg/day. Under treatment, the median prednisone dose decreased from 20.0 (interquartile range (IQR), 7-25) to 5.0 (IQR, 3-6.5) mg/day (p = .02). The incidence rate of flare decreased from 204.6 to 63.8 per 100 person-years (p = .02). Hydroxychloroquine was discontinued in 12 (44.4%) patients during follow-up, including 8 (29.6%) for ineffectiveness, and three who experienced side effects. CONCLUSION Hydroxychloroquine appears as an interesting option in sarcoidosis-associated uveitis.Abbreviations: AZA: Azathioprine; BAL: Bronchoalveolar Lavage; BCVA: Best-Corrected Visual Acuity; ENT: Ears, Nose and Throat; HCQ: Hydroxychloroquine; IOP: Intra-Ocular Pressure; IQR: interquartile range; MHC: Major Histocompatibility Complex; MMF: Mycophenolate Mofetil; MTX: Methotrexate; PMSI: Programme de Médicalisation du Système d'Information; SAU: Sarcoidosis-Associated Uveitis; SD: Standard Deviation; SUN: Standard Uveitis Nomenclature.
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Affiliation(s)
- Arthur Bert
- Department of Internal Medicine, University Hospital Lyon Croix-Rousse, Claude Bernard University - Lyon 1, Lyon, France
| | - Thomas El Jammal
- Department of Internal Medicine, University Hospital Lyon Croix-Rousse, Claude Bernard University - Lyon 1, Lyon, France
| | - Laurent Kodjikian
- Department of Ophthalmology, University Hospital Lyon Croix-Rousse, University Claude Bernard University - Lyon 1, Lyon, France
| | - Mathieu Gerfaud-Valentin
- Department of Internal Medicine, University Hospital Lyon Croix-Rousse, Claude Bernard University - Lyon 1, Lyon, France
| | - Yvan Jamilloux
- Department of Internal Medicine, University Hospital Lyon Croix-Rousse, Claude Bernard University - Lyon 1, Lyon, France
| | - Pascal Seve
- Department of Internal Medicine, University Hospital Lyon Croix-Rousse, Claude Bernard University - Lyon 1, Lyon, France
- Research on Healthcare Performance (RESHAPE), INSERM U1290, Université Claude Bernard Lyon 1, Lyon, France
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Mayovska OV, Rosenstein ED, Kramer N. Nodular Sarcoid Myositis Treated With Hydroxychloroquine Monotherapy. Cureus 2023; 15:e41000. [PMID: 37519498 PMCID: PMC10372552 DOI: 10.7759/cureus.41000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/26/2023] [Indexed: 08/01/2023] Open
Abstract
Clinically significant granulomatous inflammation of skeletal muscle in sarcoidosis is rare. Glucocorticoids are generally considered the first-line treatment of sarcoidosis, but due to their side effect profile, the addition of steroid-sparing regimens has become increasingly more common. We report a patient with nodular sarcoid myositis who was successfully treated with antimalarial hydroxychloroquine alone. Whereas antimalarials have been reported to be an effective treatment of various organ involvement in sarcoidosis, to our knowledge, this is the first report of hydroxychloroquine monotherapy successfully treating nodular sarcoid myositis. Hydroxychloroquine monotherapy may be a reasonable initial treatment option for nodular sarcoid myositis and other forms of muscular sarcoidosis, as well as for other non-acute organ-threatening manifestations of the disease.
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Affiliation(s)
| | - Elliot D Rosenstein
- Rheumatology, Overlook Medical Center, Summit, USA
- Rheumatology, Atlantic Health System, Morristown, USA
| | - Neil Kramer
- Rheumatology, Overlook Medical Center, Summit, USA
- Rheumatology, Atlantic Health System, Morristown, USA
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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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Edriss H, Kelley JS, Demke J, Nugent K. Sinonasal and Laryngeal Sarcoidosis-An Uncommon Presentation and Management Challenge. Am J Med Sci 2018; 357:93-102. [PMID: 30665498 DOI: 10.1016/j.amjms.2018.11.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Revised: 11/03/2018] [Accepted: 11/14/2018] [Indexed: 12/23/2022]
Abstract
Sarcoidosis is a chronic inflammatory disease of uncertain etiology characterized by the formation of noncaseating granulomas. The thorax is involved in 95% of cases, but any organ can be involved. Sinonasal or laryngeal involvement is uncommon and can be difficult to diagnose. The reported incidence of sarcoidosis in the upper airway clearly depends on study characteristics, and this creates uncertainty about the actual incidence. In a large prospective study in the United States, upper respiratory tract involvement occurred in 3% of the patients. Some patients have upper airway involvement without thoracic disease, and this presentation may cause delays in diagnosis. These patients have nonspecific symptoms which range from minimal nasal stuffiness to life-threatening upper airway obstruction. Currently, there is no established standard therapy for the management of upper airway sarcoidosis. These patients often respond poorly to nasal and/or inhaled corticosteroids and require long courses of oral corticosteroids. Patients with poor responses to oral corticosteroids or severe side effects may respond to tumor necrosis factor alpha inhibitors. In this review, we will discuss the clinical presentation, pathogenesis, diagnostic tests, drug treatment, surgical management options and the challenges clinicians have managing these patients.
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Affiliation(s)
- Hawa Edriss
- Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, Texas.
| | - John S Kelley
- Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, Texas
| | - Joshua Demke
- Department of Otolaryngology, Facial Plastic & Reconstructive Surgery, Texas Tech University Health Sciences Center, Lubbock, Texas
| | - Kenneth Nugent
- Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, Texas
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Edriss H, Kelley J, Demke J. Sinonasal and Laryngeal Sarcoidosis. Proc (Bayl Univ Med Cent) 2017; 30:452-454. [DOI: 10.1080/08998280.2017.11930226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Affiliation(s)
- Hawa Edriss
- Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, Texas
| | - John Kelley
- Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, Texas
| | - Joshua Demke
- Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, Texas
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Rodriguez-Caruncho C, Bielsa Marsol I. Antipalúdicos en dermatología: mecanismo de acción, indicaciones y efectos secundarios. ACTAS DERMO-SIFILIOGRAFICAS 2014. [DOI: 10.1016/j.ad.2012.10.005] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
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Rodriguez-Caruncho C, Bielsa Marsol I. Antimalarials in dermatology: mechanism of action, indications, and side effects. ACTAS DERMO-SIFILIOGRAFICAS 2014; 105:243-52. [PMID: 24656224 DOI: 10.1016/j.adengl.2012.10.021] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2012] [Accepted: 10/23/2012] [Indexed: 01/06/2023] Open
Abstract
Antimalarial drugs have been in common use in dermatology since the 1950s. Their mechanism of action is complex, and it is now known that they act through various pathways. We review the indications for antimalarials in dermatology, their adverse effects, and some less well-known effects, such as their antithrombotic and hypolipidemic action. The most recent recommendations concerning ophthalmological screening in patients on antimalarials are also reviewed.
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Affiliation(s)
- C Rodriguez-Caruncho
- Servicio de Dermatología, Hospital Universitari Germans Trias i Pujol, Universitat Autónoma de Badalona, Badalona, Barcelona, Spain.
| | - I Bielsa Marsol
- Servicio de Dermatología, Hospital Universitari Germans Trias i Pujol, Universitat Autónoma de Badalona, Badalona, Barcelona, Spain
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Morgenthau AS, Teirstein AS. Sarcoidosis of the upper and lower airways. Expert Rev Respir Med 2012; 5:823-33. [PMID: 22082167 DOI: 10.1586/ers.11.66] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Sarcoidosis is a systemic granulomatous disease of undetermined etiology characterized by a variable clinical presentation and disease course. Although clinical granulomatous inflammation may occur within any organ system, more than 90% of sarcoidosis patients have lung disease. Sarcoidosis is considered an interstitial lung disease that is frequently characterized by restrictive physiologic dysfunction on pulmonary function tests. However, sarcoidosis also involves the airways (large and small), causing obstructive airways disease. It is one of a few interstitial lung diseases that affects the entire length of the respiratory tract - from the nose to the terminal bronchioles - and causes a broad spectrum of airways dysfunction. This article examines airway dysfunction in sarcoidosis. The anatomical structure of the airways is the organizational framework for our discussion. We discuss sarcoidosis involving the nose, sinuses, nasal passages, larynx, trachea, bronchi and small airways. Common complications of airways disease, such as, atelectasis, fibrosis, bullous leions, bronchiectasis, cavitary lesions and mycetomas, are also reviewed.
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Affiliation(s)
- Adam S Morgenthau
- Department of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, 1 Gustave L. Levy Place, Box 12, New York, NY 10029, USA.
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Abstract
BACKGROUND The sinonasal system is rarely involved in the clinical picture of sarcoidosis. In the absence of pulmonary disease, sinonasal sarcoidosis is extremely rare. PATIENTS AND METHODS Four patients with isolated sarcoidosis of the nose and the sinuses are reported; in one of these patients the histological evidence was found in the mucosa of the nasopharynx. RESULTS None of these patients was found to have a pulmonary illness or any other extrapulmonary manifestation of sarcoidosis. Retrospectively, two patients fulfilled the more specific diagnostic criteria for sinonasal sarcoidosis reported in the literature. CONCLUSION Sarcoidosis should be considered in the differential diagnosis of inflammatory sinonasal disease, especially if the mucosa shows signs of granulation, but it should also be considered when an incidental finding of rhinosinusitis is recorded. Rhinosurgical intervention seems to be an appropriate therapy in terms of improving the symptoms of the disease, despite the prolonged period of postoperative healing and the necessity for individual treatment with medication. Following histological confirmation of the diagnosis, adequate medication and further appropriate diagnostic procedures drawing on internal medicine are essential.
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Affiliation(s)
- D Kleemann
- HNO-Klinik, Müritz-Klinikum GmbH, Weinbergstr. 19, 17192 Waren, Müritz.
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Long CM, Smith TL, Loehrl TA, Komorowski RA, Toohill RJ. Sinonasal disease in patients with sarcoidosis. AMERICAN JOURNAL OF RHINOLOGY 2001; 15:211-5. [PMID: 11453511 DOI: 10.2500/105065801779954157] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Sarcoidosis is a chronic granulomatous disease of unclear etiology with a propensity to involve the lower respiratory tract, but may also involve the upper respiratory tract. Histologically, it is characterized by non-caseating granulomas of various organ systems. Although nasal and sinus involvement is uncommon, patients with sarcoidosis presenting with nasal and sinus complaints may have sinonasal sarcoidosis or simply rhinosinusitis. We reviewed the cases of six patients with pulmonary sarcoidosis who developed chronic sinonasal disease. All six patients had intranasal findings consistent with sinonasal sarcoidosis, but only four had histologic evidence of sinonasal sarcoidosis. These four patients continue to require extensive therapy including topical steroids, systemic steroids, intralesional steroid injections, and nasal irrigations. We conclude that patients with histologically proven sinonasal sarcoidosis present a significant therapeutic challenge because their symptoms and physical findings are often persistent despite aggressive medical and surgical therapy. Their recalcitrant sinonasal disease is thought to result from the destruction of cilia and mucus-producing glands by the granulomatous process.
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Affiliation(s)
- C M Long
- Department of Otolaryngology and Communication Sciences, The Medical College of Wisconsin, Milwaukee 53226-9796, USA
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