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Samalia PD, Lim LL, Niederer RL. Insights into the diagnosis and management of sarcoid uveitis: A review. Clin Exp Ophthalmol 2024; 52:294-316. [PMID: 38385625 DOI: 10.1111/ceo.14366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 01/08/2024] [Accepted: 01/19/2024] [Indexed: 02/23/2024]
Abstract
Sarcoidosis is a leading cause of non-infectious uveitis that commonly affects middle-aged individuals and has a female preponderance. The disease demonstrates age, sex and ethnic differences in clinical manifestations. A diagnosis of sarcoidosis is made based on a compatible clinical presentation, supporting investigations and histologic evidence of non-caseating granulomas, although biopsy is not always possible. Multimodal imaging with widefield fundus photography, optical coherence tomography and angiography can help in the diagnosis of sarcoid uveitis and in the monitoring of treatment response. Corticosteroid remains the mainstay of treatment; chronic inflammation requires steroid-sparing immunosuppression. Features on multimodal imaging such as vascular leakage may provide prognostic indicators of outcome. Female gender, prolonged and severe uveitis, and posterior involving uveitis are associated with poorer visual outcomes.
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Affiliation(s)
- Priya D Samalia
- Department of Opthalmology, Te Whatu Ora Southern, Dunedin, New Zealand
- Otago School of Medicine, University of Otago, Dunedin, New Zealand
| | - Lyndell L Lim
- The Royal Victorian Eye and Ear Hospital, Melbourne, Australia
- Centre for Eye Research Australia, University of Melbourne, Melbourne, Australia
| | - Rachael L Niederer
- Department of Ophthalmology, Te Whatu Ora Te Toka Tumai Auckland, Auckland, New Zealand
- Department of Ophthalmology, University of Auckland, Auckland, New Zealand
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2
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Rahman R, Samiullah F, Kumar S. Exploring sarcoidosis systemic treatment: Patient factors and therapeutic strategies. Eur J Intern Med 2023; 118:139. [PMID: 37689550 DOI: 10.1016/j.ejim.2023.09.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Revised: 08/24/2023] [Accepted: 09/05/2023] [Indexed: 09/11/2023]
Affiliation(s)
- Rafiqur Rahman
- Saidu Medical College Saidu Sharif, Swat Khyber Pakhtunkhwa, Pakistan.
| | - Fnu Samiullah
- Shaheed Mohtarma Benazir Bhutto Medical College, Lyari, Karachi, Pakistan
| | - Satesh Kumar
- Shaheed Mohtarma Benazir Bhutto Medical College, Lyari, Karachi, Pakistan
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Lai J, Almazan E, Le T, Taylor MT, Alhariri J, Kwatra SG. Demographics, Cutaneous Manifestations, and Comorbidities Associated with Progressive Cutaneous Sarcoidosis: A Retrospective Cohort Study. MEDICINES (BASEL, SWITZERLAND) 2023; 10:57. [PMID: 37887264 PMCID: PMC10608652 DOI: 10.3390/medicines10100057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 08/30/2023] [Accepted: 10/09/2023] [Indexed: 10/28/2023]
Abstract
Background: Sarcoidosis is a multisystem granulomatous disease with a wide variety of presentations and clinical courses. Cutaneous manifestations and comorbidities associated with sarcoid prognosis remain understudied. Methods: An EPIC query was run for patients age 18+ at the Johns Hopkins Hospital with a diagnosis of sarcoidosis of the skin according to the ICD-10-CM code D86.3. Data were obtained from a population-based sample of 240 patients from 2015 to 2020. Results: A total of 240 patients were included in the cohort study. The mean (SD) age was 43.76 (11.72) years, and 30% of participants were male; 76.25% of patients identified as black, 19.58% as white, and 4.17% as other. The average age of onset in remissive patients was significantly higher than progressive (47 ± 12 vs. 40 ± 10, p = 0.0005); 49% of black patients experienced progressive sarcoid compared to 32.6% of white patients (p = 0.028). Progressive disease was associated with the presence of lupus pernio (aOR = 3.29, 95% CI, 1.60-6.77) and at least one autoimmune comorbidity (aOR 6.831, 95% CI 1.819-11.843). Conclusions: When controlling for patient demographics, lupus pernio and the presence of at least one autoimmune condition were associated with progressive cutaneous sarcoidosis.
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Affiliation(s)
| | | | | | | | | | - Shawn G. Kwatra
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA; (J.L.); (T.L.); (M.T.T.); (J.A.)
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Linkova N, Diatlova A, Zinchenko Y, Kornilova A, Snetkov P, Morozkina S, Medvedev D, Krasichkov A, Polyakova V, Yablonskiy P. Pulmonary Sarcoidosis: Experimental Models and Perspectives of Molecular Diagnostics Using Quantum Dots. Int J Mol Sci 2023; 24:11267. [PMID: 37511027 PMCID: PMC10379333 DOI: 10.3390/ijms241411267] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Revised: 07/05/2023] [Accepted: 07/07/2023] [Indexed: 07/30/2023] Open
Abstract
Sarcoidosis is a complex inflammatory multisystem disease of unknown etiology that is characterised by epithelioid cell granulomatous lesions affecting various organs, mainly the lungs. In general, sarcoidosis is asymptomatic, but some cases result in severe complications and organ failure. So far, no accurate and validated modelling for clinical and pathohistological manifestations of sarcoidosis is suggested. Moreover, knowledge about disease-specific diagnostic markers for sarcoidosis is scarce. For instance, pulmonary granulomatosis is associated with the upregulated production of proinflammatory molecules: TNF-α, IL-6, CXCL1, CCL2, CCL18, CD163, serum angiotensin-converting enzyme (sACE), lysozyme, neopterin, and serum amyloid A (SAA). Quantum dots (QDs) are widely applied for molecular diagnostics of various diseases. QDs are semiconductor nanoparticles of a few nanometres in size, made from ZnS, CdS, ZnSe, etc., with unique physical and chemical properties that are useful for the labelling and detection in biological experiments. QDs can conjugate with various antibodies or oligonucleotides, allowing for high-sensitivity detection of various targets in organs and cells. Our review describes existing experimental models for sarcoidosis (in vitro, in vivo, and in silico), their advantages and restrictions, as well as the physical properties of quantum dots and their potential applications in the molecular diagnostics of sarcoidosis. The most promising experimental models include mice with TSC2 deletion and an in silico multiscale computational model of sarcoidosis (SarcoidSim), developed using transcriptomics and flow cytometry of human sarcoid biopsies. Both models are most efficient to test different candidate drugs for sarcoidosis.
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Affiliation(s)
- Natalia Linkova
- St. Petersburg Research Institute of Phthisiopulmonology, Ligovskii Prospect, 2-4, 191036 Saint Petersburg, Russia
- St. Petersburg Institute of Bioregulation and Gerontology, Dynamo pr., 3, 197110 Saint Petersburg, Russia
| | - Anastasiia Diatlova
- St. Petersburg Research Institute of Phthisiopulmonology, Ligovskii Prospect, 2-4, 191036 Saint Petersburg, Russia
| | - Yulia Zinchenko
- St. Petersburg Research Institute of Phthisiopulmonology, Ligovskii Prospect, 2-4, 191036 Saint Petersburg, Russia
| | - Anastasiia Kornilova
- St. Petersburg Research Institute of Phthisiopulmonology, Ligovskii Prospect, 2-4, 191036 Saint Petersburg, Russia
| | - Petr Snetkov
- St. Petersburg Research Institute of Phthisiopulmonology, Ligovskii Prospect, 2-4, 191036 Saint Petersburg, Russia
- Chemical Bioengineering Center, ITMO University, Kronverksky Pr, 49A, 197101 Saint Petersburg, Russia
| | - Svetlana Morozkina
- St. Petersburg Research Institute of Phthisiopulmonology, Ligovskii Prospect, 2-4, 191036 Saint Petersburg, Russia
- Chemical Bioengineering Center, ITMO University, Kronverksky Pr, 49A, 197101 Saint Petersburg, Russia
| | - Dmitrii Medvedev
- St. Petersburg Institute of Bioregulation and Gerontology, Dynamo pr., 3, 197110 Saint Petersburg, Russia
| | - Alexandr Krasichkov
- Department of Radio Engineering Systems, Electrotechnical University "LETI", Prof. Popova Street 5F, 197022 Saint Petersburg, Russia
| | - Victoria Polyakova
- St. Petersburg Research Institute of Phthisiopulmonology, Ligovskii Prospect, 2-4, 191036 Saint Petersburg, Russia
| | - Piotr Yablonskiy
- St. Petersburg Research Institute of Phthisiopulmonology, Ligovskii Prospect, 2-4, 191036 Saint Petersburg, Russia
- Department of Hospital Surgery of the Faculty of Medicine, St. Petersburg State University, University Embankment, 7-9, 199034 Saint Petersburg, Russia
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Adouli J, Aaron Fried, Rachel Swier, Andrew Ghio, Irina Petrache, Stephen Tilley. Cellular Recycling Gone Wrong: The Role of Dysregulated Autophagy and Hyperactive mTORC1 in the Pathogenesis of Sarcoidosis. SARCOIDOSIS, VASCULITIS, AND DIFFUSE LUNG DISEASES : OFFICIAL JOURNAL OF WASOG 2023; 40:e2023016. [PMID: 37382074 PMCID: PMC10494747 DOI: 10.36141/svdld.v40i2.13498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Accepted: 05/02/2023] [Indexed: 06/30/2023]
Abstract
BACKGROUND AND AIMS Autophagy is a highly regulated, complex intracellular recycling process that is vital to maintaining cellular homeostasis in response to diverse conditions and stressors. Despite the presence of robust regulatory pathways, the intricate and multi-step nature of autophagy creates opportunity for dysregulation. Errors in autophagy have been implicated in the development of a broad range of clinical pathologies including granulomatous disease. Specifically, activation of the mTORC1 pathway has been identified as a key negative regulator of autophagic flux, prompting the study of dysregulated mTORC1 signaling in the pathogenesis of sarcoidosis. Our review: We conducted a thorough search of the extant literature to identify the regulatory pathways of autophagy, and more specifically the implication of upregulated mTORC1 pathways in the pathogenesis of sarcoidosis. We review data showing spontaneous granuloma formation in animal models with upregulate mTORC1 signaling, human genetic studies showing mutation in autophagy genes in sarcoidosis patients, and clinical data showing that targeting autophagy regulatory molecules like mTORC1 may provide new therapeutic approaches for sarcoidosis. CONCLUSIONS Given the incomplete understanding of sarcoidosis pathogenesis and the toxicities of current treatments, a more complete understanding of sarcoidosis pathogenesis is crucial for the development of more effective and safer therapies. In this review, we propose a strong molecular pathway driving sarcoidosis pathogenesis at which autophagy is at the center. A more complete understanding of autophagy and its regulatory molecules, like mTORC1, may provide a window into new therapeutic approaches for sarcoidosis.
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Affiliation(s)
- Jennifer Adouli
- Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, USA; UNC Sarcoidosis Center, University of North Carolina at Chapel Hill, Chapel Hill, USA.
| | - Aaron Fried
- Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, USA.
| | - Rachel Swier
- Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, USA; UNC Sarcoidosis Center, University of North Carolina at Chapel Hill, Chapel Hill, USA.
| | - Andrew Ghio
- UNC Sarcoidosis Center, University of North Carolina at Chapel Hill, Chapel Hill, USA; National Health and Environmental Effects Research Laboratory, Environmental Protection Agency, Chapel Hill, USA.
| | - Irina Petrache
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, National Jewish Health, Denver, USA.
| | - Stephen Tilley
- Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, USA; UNC Sarcoidosis Center, University of North Carolina at Chapel Hill, Chapel Hill, USA.
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Xiong Y, Kullberg S, Garman L, Pezant N, Ellinghaus D, Vasila V, Eklund A, Rybicki BA, Iannuzzi MC, Schreiber S, Müller-Quernheim J, Montgomery CG, Grunewald J, Padyukov L, Rivera NV. Sex differences in the genetics of sarcoidosis across European and African ancestry populations. Front Med (Lausanne) 2023; 10:1132799. [PMID: 37250650 PMCID: PMC10213734 DOI: 10.3389/fmed.2023.1132799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Accepted: 04/10/2023] [Indexed: 05/31/2023] Open
Abstract
Background Sex differences in the susceptibility of sarcoidosis are unknown. The study aims to identify sex-dependent genetic variations in two clinical sarcoidosis phenotypes: Löfgren's syndrome (LS) and non-Löfgren's syndrome (non-LS). Methods A meta-analysis of genome-wide association studies was conducted on Europeans and African Americans, totaling 10,103 individuals from three population-based cohorts, Sweden (n = 3,843), Germany (n = 3,342), and the United States (n = 2,918), followed by an SNP lookup in the UK Biobank (UKB, n = 387,945). A genome-wide association study based on Immunochip data consisting of 141,000 single nucleotide polymorphisms (SNPs) was conducted in the sex groups. The association test was based on logistic regression using the additive model in LS and non-LS sex groups independently. Additionally, gene-based analysis, gene expression, expression quantitative trait loci (eQTL) mapping, and pathway analysis were performed to discover functionally relevant mechanisms related to sarcoidosis and biological sex. Results We identified sex-dependent genetic variations in LS and non-LS sex groups. Genetic findings in LS sex groups were explicitly located in the extended Major Histocompatibility Complex (xMHC). In non-LS, genetic differences in the sex groups were primarily located in the MHC class II subregion and ANXA11. Gene-based analysis and eQTL enrichment revealed distinct sex-specific gene expression patterns in various tissues and immune cell types. In LS sex groups, a pathway map related to antigen presentation machinery by IFN-gamma. In non-LS, pathway maps related to immune response lectin-induced complement pathway in males and related to maturation and migration of dendritic cells in skin sensitization in females were identified. Conclusion Our findings provide new evidence for a sex bias underlying sarcoidosis genetic architecture, particularly in clinical phenotypes LS and non-LS. Biological sex likely plays a role in disease mechanisms in sarcoidosis.
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Affiliation(s)
- Ying Xiong
- Respiratory Medicine Division, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Susanna Kullberg
- Respiratory Medicine Division, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
- Department of Respiratory Medicine and Allergy, Theme Inflammation and Ageing, Karolinska University Hospital, Stockholm, Sweden
| | - Lori Garman
- Genes and Human Disease, Oklahoma Medical Research Foundation, Oklahoma City, OK, United States
| | - Nathan Pezant
- Genes and Human Disease, Oklahoma Medical Research Foundation, Oklahoma City, OK, United States
| | - David Ellinghaus
- Institute of Clinical Molecular Biology, Christian-Albrechts-University of Kiel, Kiel, Germany
| | - Vasiliki Vasila
- Respiratory Medicine Division, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Anders Eklund
- Department of Respiratory Medicine and Allergy, Theme Inflammation and Ageing, Karolinska University Hospital, Stockholm, Sweden
| | - Benjamin A. Rybicki
- Department of Public Health Sciences, Henry Ford Health System, Detroit, MI, United States
| | - Michael C. Iannuzzi
- Zucker School of Medicine, Staten Island University Hospital, Northwell/Hofstra University, Staten Island, NY, United States
| | - Stefan Schreiber
- Institute of Clinical Molecular Biology, Christian-Albrechts-University of Kiel, Kiel, Germany
- Clinic for Internal Medicine I, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Joachim Müller-Quernheim
- Department of Pneumology, University Medical Center Freiburg, Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany
| | - Courtney G. Montgomery
- Genes and Human Disease, Oklahoma Medical Research Foundation, Oklahoma City, OK, United States
| | - Johan Grunewald
- Respiratory Medicine Division, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
- Department of Respiratory Medicine and Allergy, Theme Inflammation and Ageing, Karolinska University Hospital, Stockholm, Sweden
- Center for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Leonid Padyukov
- Center for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden
- Division of Rheumatology, Department of Medicine Solna, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Natalia V. Rivera
- Respiratory Medicine Division, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
- Center for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden
- Division of Rheumatology, Department of Medicine Solna, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
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7
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Hu X, Zou L, Wang S, Zeng T, Li P, Shen Y, Chen L. Performance of Serum Angiotensin-Converting Enzyme in Diagnosing Sarcoidosis and Predicting the Active Status of Sarcoidosis: A Meta-Analysis. Biomolecules 2022; 12:biom12101400. [PMID: 36291609 PMCID: PMC9599650 DOI: 10.3390/biom12101400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 09/23/2022] [Accepted: 09/28/2022] [Indexed: 11/16/2022] Open
Abstract
The usefulness of serum angiotensin-converting enzyme (sACE) for diagnosing sarcoidosis and determining the active status of sarcoidosis has been reported with varying outcomes. On the basis of the majority of published data, we conducted a meta-analysis to calculate the overall predictive accuracy of sACE in sarcoidosis disease and the active status of sarcoidosis. The inclusion of related research listed in Web of Science, PubMed, Scopus, and other literature databases was assessed. SROC curves were generated to characterize the overall test results after data on sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), and diagnostic odds ratio (DOR) were combined. Publication bias was identified using Deeks’ funnel plot. Thirty-five publications with 8645 subjects met the inclusion criteria. The following are summary estimates of sACE diagnostic performance for sarcoidosis: sensitivity, 60% (95% confidence interval (CI), 52–68%); specificity, 93% (95% CI, 88–96%); PLR, 8.4 (95% CI, 5.3–13.3); NLR, 0.43 (95% CI, 0.36–0.52); and DOR, 19 (95% CI, 12–31). The area under the SROC curve (AUC) was 0.84 (95% CI, 0.80–0.87). Summary estimates for predicting the active status of sarcoidosis were as follows: sensitivity, 0.76 (95% CI, 0.61–0.87); specificity, 0.80 (95% CI, 0.64–0.90); PLR, 3.9 (95% CI, 2.1–7.3); NLR, 0.29 (95% CI, 0.17–0.49); and DOR, 13 (95% CI, 6–31). The AUC was 0.85 (95% CI, 0.82–0.88). There was no evidence of publication bias. Our meta-analysis suggests that measuring the sACE may assist in the diagnosis of sarcoidosis and predicting the active status of sarcoidosis, but the interpretation of the sACE results should be with caution. Future studies should validate our results.
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Affiliation(s)
- Xueru Hu
- Department of Respiratory and Critical Care Medicine, West China Hospital of Sichuan University and Division of Pulmonary Diseases, State Key Laboratory of Biotherapy of China, Chengdu 610041, China
| | - Li Zou
- Department of Pediatric Surgery, West China Hospital of Sichuan University, Chengdu 610041, China
| | - Shuyan Wang
- Department of Respiratory and Critical Care Medicine, West China Hospital of Sichuan University and Division of Pulmonary Diseases, State Key Laboratory of Biotherapy of China, Chengdu 610041, China
| | - Tingting Zeng
- Department of Respiratory and Critical Care Medicine, West China Hospital of Sichuan University and Division of Pulmonary Diseases, State Key Laboratory of Biotherapy of China, Chengdu 610041, China
| | - Ping Li
- Department of Respiratory and Critical Care Medicine, West China Hospital of Sichuan University and Division of Pulmonary Diseases, State Key Laboratory of Biotherapy of China, Chengdu 610041, China
| | - Yongchun Shen
- Department of Respiratory and Critical Care Medicine, West China Hospital of Sichuan University and Division of Pulmonary Diseases, State Key Laboratory of Biotherapy of China, Chengdu 610041, China
- Correspondence: (Y.S.); (L.C.); Tel.: +86-28-85422380 (Y.S. & L.C.); Fax: +86-28-85582944 (Y.S. & L.C.)
| | - Lei Chen
- Department of Respiratory and Critical Care Medicine, West China Hospital of Sichuan University and Division of Pulmonary Diseases, State Key Laboratory of Biotherapy of China, Chengdu 610041, China
- Correspondence: (Y.S.); (L.C.); Tel.: +86-28-85422380 (Y.S. & L.C.); Fax: +86-28-85582944 (Y.S. & L.C.)
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Wu JH, Imadojemu S, Caplan AS. The Evolving Landscape of Cutaneous Sarcoidosis: Pathogenic Insight, Clinical Challenges, and New Frontiers in Therapy. Am J Clin Dermatol 2022; 23:499-514. [PMID: 35583850 DOI: 10.1007/s40257-022-00693-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/07/2022] [Indexed: 12/13/2022]
Abstract
Sarcoidosis is a multisystem disorder of unknown etiology characterized by accumulation of granulomas in affected tissue. Cutaneous manifestations are among the most common extrapulmonary manifestations in sarcoidosis and can lead to disfiguring disease requiring chronic therapy. In many patients, skin disease may be the first recognized manifestation of sarcoidosis, necessitating a thorough evaluation for systemic involvement. Although the precise etiology of sarcoidosis and the pathogenic mechanisms leading to granuloma formation, persistence, or resolution remain unclear, recent research has led to significant advances in our understanding of this disease. This article reviews recent advances in epidemiology, sarcoidosis clinical assessment with a focus on the dermatologist's role, disease pathogenesis, and new therapies in use and under investigation for cutaneous and systemic sarcoidosis.
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Affiliation(s)
- Julie H Wu
- Ronald O. Perelman Department of Dermatology, New York University Grossman School of Medicine, 240 East 38th Street, 11th Floor, New York, NY, 10016, USA
| | - Sotonye Imadojemu
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Avrom S Caplan
- Ronald O. Perelman Department of Dermatology, New York University Grossman School of Medicine, 240 East 38th Street, 11th Floor, New York, NY, 10016, USA.
- New York University Sarcoidosis Program, New York University Grossman School of Medicine, New York, NY, USA.
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Choi JY, Lee JH, Seo JM, Yun SY, Koo HYR, Yu DS, Lee YB. Incidence and death rate of sarcoidosis in Korea in association with metabolic diseases. J Dermatol 2022; 49:488-495. [PMID: 35040161 DOI: 10.1111/1346-8138.16303] [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: 09/07/2021] [Revised: 11/10/2021] [Accepted: 12/24/2021] [Indexed: 11/29/2022]
Abstract
Sarcoidosis is a systemic granulomatous disease that affects a variety of organs. Although the etiology has not been fully understood, it is thought that diverse genetic and environmental factors interact with the immune system to develop granulomas. The incidence and death rate of sarcoidosis vary according to race. This study was conducted to identify the epidemiology of sarcoidosis in Korea and reveal its association with comorbid diseases such as diabetes mellitus, hypertension, and dyslipidemia in a population-based database. We retrospectively analyzed Korean National Health Insurance claims data between 2006 and 2017. The average annual incidence from 2006 to 2017 was 0.82/100 000 person-years and the all-cause death rate in sarcoidosis patients was 9.25/1000 cases. The incidence of sarcoidosis was higher in patients with diabetes mellitus, hypertension, and dyslipidemia than patients without those underlying diseases. Sarcoidosis patients with diabetes mellitus and hypertension showed an increased death rate after adjusting the confounding factors (hazard ratio [95% confidence interval], 1.66 [1.23-2.23] and 1.73 [1.29-2.31] respectively), however, patients with dyslipidemia showed a low death rate (HR = 0.64 [0.46-0.88]). In conclusion, we found that sarcoidosis is associated with diabetes mellitus, hypertension, and dyslipidemia and that diabetes mellitus and hypertension increase the risk of death in sarcoidosis patients. Extra caution is needed in sarcoidosis patients who already have these metabolic diseases.
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Affiliation(s)
- Jin Young Choi
- Department of Dermatology, College of Medicine, The Catholic University of Korea, Uijeongbu, Korea
| | - Joo Hee Lee
- Department of Dermatology, College of Medicine, The Catholic University of Korea, Uijeongbu, Korea
| | - Ji Min Seo
- Department of Dermatology, College of Medicine, The Catholic University of Korea, Uijeongbu, Korea
| | - So Yeon Yun
- Department of Dermatology, College of Medicine, The Catholic University of Korea, Uijeongbu, Korea
| | - Ha Yeh Rin Koo
- Department of Dermatology, College of Medicine, The Catholic University of Korea, Uijeongbu, Korea
| | - Dong Soo Yu
- Department of Dermatology, College of Medicine, The Catholic University of Korea, Uijeongbu, Korea
| | - Young Bok Lee
- Department of Dermatology, College of Medicine, The Catholic University of Korea, Uijeongbu, Korea
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10
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Haraldsdóttir SÓ, Jonasson JG, Jorundsdottir KB, Hannesson HJ, Gislason T, Gudbjornsson B. Sarcoidosis in Iceland: a nationwide study of epidemiology, clinical picture and environmental exposure. ERJ Open Res 2021; 7:00550-2021. [PMID: 34912885 PMCID: PMC8666626 DOI: 10.1183/23120541.00550-2021] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Accepted: 09/22/2021] [Indexed: 11/24/2022] Open
Abstract
Background This nationwide study aimed to elucidate the incidence and clinical characteristics of tissue-verified sarcoidosis in Iceland. A secondary aim was to analyse sex differences and identify possible environmental factors contributing to the pathological process. Materials and methods This is a descriptive study covering 36 years (January 1, 1981 through December 31, 2016). Histopathological reports and electronic hospital discharge registries were reviewed in context for granulomas and/or sarcoidosis. National data were used for comparison regarding smoking habits and occupation, adjusted for age, sex and year of diagnosis. The data were stored in FileMaker and calculations were made by extracting data from this database to the statistical software package R. Results A total of 418 patients (54% females) were diagnosed with tissue-verified sarcoidosis. The incidence rate was 4.15/100 000/year, similar among females and males. The mean age at diagnosis was higher among females (53.0±14.2 years) than males (48.2±13.8 years). Fatigue was the most frequent single symptom (49.7%), but when all respiratory symptoms were grouped, they were the most frequent symptoms (60%). No significant difference was found between smoking status and sarcoidosis. Possible hazardous exposure in the workplace was reported by 19.4% of the cases. Conclusion The incidence of sarcoidosis in Iceland was higher than in an Asian population where the same inclusion criteria were applied. The clinical picture diverges partly from that in the Asian population but resembles that among other Caucasians. Fatigue and respiratory symptoms were predominant. The biphasic pattern of age at disease debut seen elsewhere among females was not evident in Iceland. This paper describes a nationwide study on the incidence of tissue-verified sarcoidosis in Iceland, focusing on clinical symptoms, smoking and occupation. The incidence is low, and main symptoms are fatigue and symptoms of the respiratory tract.https://bit.ly/3ur6jk8
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Affiliation(s)
| | - Jon Gunnlaugur Jonasson
- Dept of Pathology, Landspitali University Hospital, Reykjavik, Iceland.,Faculty of Medicine, University of Iceland, Reykjavik, Iceland
| | | | | | - Thorarinn Gislason
- Faculty of Medicine, University of Iceland, Reykjavik, Iceland.,Dept of Sleep, Landspitali University Hospital, Reykjavik, Iceland
| | - Bjorn Gudbjornsson
- Faculty of Medicine, University of Iceland, Reykjavik, Iceland.,Centre for Rheumatology Research, Landspitali University Hospital, Reykjavik, Iceland
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Alba AC, Gupta S, Kugathasan L, Ha A, Ochoa A, Balter M, Sosa Liprandi A, Sosa Liprandi MI. Cardiac Sarcoidosis: A Clinical Overview. Curr Probl Cardiol 2021; 46:100936. [PMID: 34400001 DOI: 10.1016/j.cpcardiol.2021.100936] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Accepted: 07/17/2021] [Indexed: 12/26/2022]
Abstract
Cardiac sarcoidosis (CS) with clinical manifestation occurs in about 5-8% of patients with sarcoidosis. CS may be clinically suspected by the presence of ventricular arrhythmia, conduction abnormalities, and heart failure (HF). However, 20%-25% of patients may present with silent CS, having asymptomatic cardiac involvement. The diagnosis of CS is based on findings from nuclear studies, cardiac magnetic resonance, and extra-cardiac tissue biopsy. Due to the inflammatory nature of the disease, immunosuppressive medications are a cornerstone of therapy. The treatment also includes recommended HF medical therapies. Since CS patients are at risk of sudden cardiac death resulting from progression of cardiac dysfunction or the presence of scar originating from fatal arrhythmias, implantable cardioverter-defibrillators should be considered, with special indication beyond accepted recommendations in HF. In CS, the extent of left ventricular dysfunction is the most important mortality predictor. Heart transplant or mechanical circulatory support may represent life saving strategies in selective CS patients.
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Affiliation(s)
- Ana Carolina Alba
- Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada.
| | - Shyla Gupta
- Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada
| | - Lakshmi Kugathasan
- Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada
| | - Andrew Ha
- Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada
| | - Alejandro Ochoa
- Echocardiography, Cardioestudio, Clinica Las Vegas, Medellin, Colombia
| | - Meyer Balter
- Division of Respiratory Medicine, Mount Sinai Hospital and University Health Network, Toronto, Ontario, Canada
| | - Alvaro Sosa Liprandi
- Department of Cardiology and Heart Failure, Sanatorio Güemes, Buenos Aires, Argentina
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Elżbieta R, Iwona K, Joanna B, Karina JR, Piotr R. Role of fibrocytes and endothelial progenitor cells among low-differentiated CD34+ cells in the progression of lung sarcoidosis. BMC Pulm Med 2020; 20:306. [PMID: 33218322 PMCID: PMC7678043 DOI: 10.1186/s12890-020-01345-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Accepted: 11/12/2020] [Indexed: 12/18/2022] Open
Abstract
Background Sarcoidosis is a multisystemic granulomatous disease with still unknown etiology. Our previous studies showed a significantly higher percentage of CD34 + cells in the peripheral blood in patients with sarcoidosis (SA) compared to the control group. The objective of the present study was to characterized of the CD34 + cell population in peripheral blood in patients with SA with reference to the control group. Moreover in patients with SA, fibrocytes and endothelial cells were analysed and their relationship to the fibrosis process based on assessment of diffusing capacity for carbon monoxide (DLCO). Methods Data from patients diagnosed with SA at Military Institute of Medicine (Warsaw, Poland) between January 2018 and December 2019 were collected and analysed ongoing basis. Peripheral blood was collected from 26 patients with newly diagnosed pulmonary SA and 16 healthy subjects. The immunomagnetic method and flow cytometry were used. Among the CD34+ progenitor cells were assessed: low-differentiated cells, hematopoietic progenitor cells and endothelial progenitor cells. The Statistica 12.0 software was used for a statistical analysis. Results We observed a significantly higher percentage of low-differentiated cells (13.8 vs. 2.3, P = 0.001) and endothelial cells (0.3 vs. 0.0, P = 0.001) in patients with SA compared to the control group. In the study group the median proportion of fibrocytes was 1.877% (0.983–2.340) in patients with DLCO< 80%, while in patients with DLCO> 80% was 0.795% (0.139–1.951) (P = 0.72). The median proportion of endothelial progenitor cells was higher in patients with DLCO< 80%: 0.889% (0.391–1.741), than in patients with DLCO> 80%: 0.451% (0.177–0.857) (P = 0.44). Conclusions In conclusion we demonstrated for the first time the immunophenotype of peripheral CD34 + cells with the degree of their differentiation. The study confirmed the involvement of low differentiated cells and endothelial cells in patients with SA.
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Affiliation(s)
- Rutkowska Elżbieta
- Department of Internal Medicine and Hematology, Laboratory of Hematology and Flow Cytometry, Military Institute of Medicine, Warsaw, Poland.
| | - Kwiecień Iwona
- Department of Internal Medicine and Hematology, Laboratory of Hematology and Flow Cytometry, Military Institute of Medicine, Warsaw, Poland
| | - Bednarek Joanna
- Department of Internal Medicine, Pulmonology, Allergology and Clinical Immunology, Military Institute of Medicine, Warsaw, Poland
| | - Jahnz-Różyk Karina
- Department of Internal Medicine, Pulmonology, Allergology and Clinical Immunology, Military Institute of Medicine, Warsaw, Poland
| | - Rzepecki Piotr
- Department of Internal Medicine and Hematology, Military Institute of Medicine, Warsaw, Poland
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Modi T, Maniam G, Quirch M, Warraich I, Rehman S. Extrapulmonary sarcoidosis in an atypical patient demographic. Proc (Bayl Univ Med Cent) 2020; 34:151-152. [PMID: 33456182 DOI: 10.1080/08998280.2020.1824963] [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: 10/23/2022] Open
Abstract
Although it typically presents with cough and dyspnea due to pulmonary involvement, sarcoidosis is a multisystem granulomatous disease and therefore may present with extrapulmonary manifestations. Cutaneous manifestations are common, while hepatic sarcoidosis is uncommon and osseous manifestations are exceedingly rare. This article describes osseous, hepatic, and cutaneous manifestations due to sarcoidosis. The patient was diagnosed with sarcoidosis, treated with a dynamic hip screw implant with a derotational screw, and discharged on a new medication regimen: vitamin D, calcium supplements, alendronate, methotrexate, and hydroxychloroquine.
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Affiliation(s)
- Trisha Modi
- School of Medicine, Texas Tech University Health Sciences Center, Lubbock, Texas
| | - Ganesh Maniam
- School of Medicine, Texas Tech University Health Sciences Center, Lubbock, Texas
| | - Miguel Quirch
- Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, Texas
| | - Irfan Warraich
- Department of Pathology, Texas Tech University Health Sciences Center, Lubbock, Texas
| | - Shabnam Rehman
- Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, Texas
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Alnaimat F, Al Oweidat K, Alrwashdeh A, Alnashrati A, Barham S, Hijaz M, Murad D, Alshelleh S, Obeidat N. Sarcoidosis in Jordan: A Study of the Clinical Phenotype and Disease Outcome. Arch Rheumatol 2020; 35:226-238. [PMID: 32851372 PMCID: PMC7406155 DOI: 10.46497/archrheumatol.2020.7584] [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: 05/04/2019] [Accepted: 07/16/2019] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES This study aims to evaluate the clinical phenotypic features of sarcoidosis in a single-center academic hospital in Jordan. PATIENTS AND METHODS A retrospective file review was performed at an academic medical center in Jordan that included all patients diagnosed with sarcoidosis between January 2000 and December 2018. A total of 150 patients with sarcoidosis (38 males, 112 females; mean age 47.8±11.7 years; range, 17 to 79 years) were evaluated. Clinical data extracted from the files included the sex of the patient, the age at time of diagnosis, diagnosis date, the season during which the diagnosis was established, and smoking history. Biopsy histopathology, spirometry, nerve conduction, echocardiography, and imaging reports including plain radiographs, ultrasonographic, magnetic resonance and computed tomography reports were reviewed. Data including laboratory values, medication usage, clinical outcomes, and morbidity/mortality were collected. Pulmonary function tests including spirometry and lung volumes along with the diffusing capacity for carbon monoxide were reviewed for the presence of restriction, obstruction or reduction in the diffusion capacity of carbon monoxide. Identification of extra-thoracic organ involvement was determined in each patient in accordance with the criteria suggested by the updated World Association of Sarcoidosis and Other Granulomatous Disorders. RESULTS A total of 77.3% of the patients were diagnosed by biopsy. One case of Lofgren's syndrome was identified. Of the patients, 18.0% had isolated pulmonary sarcoidosis, 75.3% had pulmonary and extra-pulmonary sarcoidosis and 6.7% had isolated extra-pulmonary sarcoidosis while 81.3% had respiratory symptoms, mostly shortness of breath and cough. Extra-thoracic organ involvement mostly involved the musculoskeletal system (33%) followed by the skin (20%). Female patients had more extra-thoracic involvement but the sex difference was only statistically significant for cutaneous involvement. Of the patients, 84% received treatment while 20% had disease remission during the first two years after diagnosis and 70% required treatment beyond two years after diagnosis. CONCLUSION Various sarcoidosis clinical phenotypes are seen among Jordanian patients. Jordanian females are more affected by the disease and have more extra-thoracic involvement compared to male patients. A large number of the study patients received treatment.
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Affiliation(s)
- Fatima Alnaimat
- Department of Internal Medicine, Division of Rheumatology, University of Jordan, Amman, Jordan
| | - Khaled Al Oweidat
- Department of Internal Medicine, Division of Respiratory and Sleep Medicine, University of Jordan, Amman, Jordan
| | - Anas Alrwashdeh
- Department of Internal Medicine, University of Jordan, Amman, Jordan
| | - Ahmad Alnashrati
- Department of Internal Medicine, University of Jordan, Amman, Jordan
| | - Saba Barham
- Department of Internal Medicine, University of Jordan, Amman, Jordan
| | - Mohammad Hijaz
- Department of Internal Medicine, University of Jordan, Amman, Jordan
| | - Dina Murad
- Department of Internal Medicine, University of Jordan, Amman, Jordan
| | - Sameeha Alshelleh
- Department of Internal Medicine Division of Nephrology, University of Jordan, Amman, Jordan
| | - Nathir Obeidat
- Department of Internal Medicine, Division of Respiratory and Sleep Medicine, University of Jordan, Amman, Jordan
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Pandit P, Perez RL, Roman J. Sex-Based Differences in Interstitial Lung Disease. Am J Med Sci 2020; 360:467-473. [PMID: 32487327 DOI: 10.1016/j.amjms.2020.04.023] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Revised: 04/18/2020] [Accepted: 04/18/2020] [Indexed: 12/16/2022]
Abstract
Interstitial lung diseases comprise a family of progressive pulmonary disorders that are often idiopathic or associated with various systemic diseases and that is characterized by bilateral lung involvement with inflammation and tissue remodeling or fibrosis. The impact of sex, including the anatomic and physiologic traits that one is born with, on the development and progression of interstitial lung diseases is not entirely clear. Variances between men and women are driven by differences in male and female biology and sex hormones, among other differences, but their role remains uncertain. In this review, we summarize sex-related differences in the epidemiology and progression of certain interstitial lung diseases with a focus on the connective tissue related interstitial lung diseases, idiopathic pulmonary fibrosis, and sarcoidosis. We also discuss cellular and pre-clinical studies that might shed light on the potential mechanisms responsible for these differences in the hope of unveiling potential targets for intervention and stimulating research in this needed field of investigation.
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Affiliation(s)
- Pooja Pandit
- Department of Medicine, Division of Pulmonary, Allergy and Critical Care, Sidney Kimmel College of Medicine; Jane & Leonard Korman Respiratory Institute, Jefferson Health, Thomas Jefferson University, 834 Walnut St, Philadelphia, PA 19107 USA
| | - Rafael L Perez
- Department of Medicine, Division of Pulmonary, Allergy and Critical Care, Sidney Kimmel College of Medicine; Jane & Leonard Korman Respiratory Institute, Jefferson Health, Thomas Jefferson University, 834 Walnut St, Philadelphia, PA 19107 USA
| | - Jesse Roman
- Department of Medicine, Division of Pulmonary, Allergy and Critical Care, Sidney Kimmel College of Medicine; Jane & Leonard Korman Respiratory Institute, Jefferson Health, Thomas Jefferson University, 834 Walnut St, Philadelphia, PA 19107 USA.
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16
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Varu DM, Rhee MK, Akpek EK, Amescua G, Farid M, Garcia-Ferrer FJ, Lin A, Musch DC, Mah FS, Dunn SP. Conjunctivitis Preferred Practice Pattern®. Ophthalmology 2019; 126:P94-P169. [DOI: 10.1016/j.ophtha.2018.10.020] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Accepted: 10/09/2018] [Indexed: 02/07/2023] Open
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17
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Hattori T, Konno S, Shijubo N, Yamaguchi T, Sugiyama Y, Honma S, Inase N, Ito YM, Nishimura M. Nationwide survey on the organ-specific prevalence and its interaction with sarcoidosis in Japan. Sci Rep 2018; 8:9440. [PMID: 29930245 PMCID: PMC6013472 DOI: 10.1038/s41598-018-27554-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Accepted: 05/31/2018] [Indexed: 01/09/2023] Open
Abstract
Previous studies attempted to characterize the subjects with sarcoidosis according to differences in sex, age, and the presence of specific organ involvement. However, significant interactions among these factors precluded a clear conclusion based on simple comparison. This study aimed to clarify the age- and sex-stratified prevalence of specific organ involvement and the heterogenous nature of sarcoidosis. Using the data of 9,965 patients who were newly registered into a database at the Ministry of Health, Labour and Welfare, Japan between 2002 and 2011, we evaluated the age- and sex-specific prevalence of the eye, lung, and skin involvement of sarcoidosis. We also attempted corresponding analysis considering multiple factors. As compared with several decades ago, the monophasic age distribution in men became biphasic, and the biphasic distribution in women, monophasic. The prevalence of pulmonary and cutaneous lesions was significantly associated with age, whereas the prevalence of ocular involvement showed a biphasic pattern. The prevalence of bilateral hilar lymphadenopathy was significantly higher, whereas the prevalence of diffuse lung shadow was significantly lower, in subjects with ocular involvement than those without ocular involvement. Corresponding analysis visually clarified the complex interactions among factors. Our results contribute to a better understanding of the heterogeneous features of sarcoidosis.
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Affiliation(s)
- Takeshi Hattori
- First Department of Medicine, Hokkaido University School of Medicine, Sapporo, Japan.,Department of Respiratory Medicine, National Hospital Organization Hokkaido Medical Center, Sapporo, Japan
| | - Satoshi Konno
- First Department of Medicine, Hokkaido University School of Medicine, Sapporo, Japan.
| | - Noriharu Shijubo
- Department of Respiratory Medicine, JR Sapporo Hospital, Sapporo, Japan
| | | | - Yukihiko Sugiyama
- Department of Pulmonary Medicine, Nerima Hikarigaoka Hospital, Tokyo, Japan
| | - Sakae Honma
- Division of Respiratory Medicine, Toho University Omori Medical Center, Tokyo, Japan
| | - Naohiko Inase
- Department of Respiratory Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Yoichi M Ito
- Department of Biostatistics, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Masaharu Nishimura
- First Department of Medicine, Hokkaido University School of Medicine, Sapporo, Japan
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Abstract
Musculoskeletal manifestations in the context of sarcoidosis are frequently observed. The rheumatologist regularly encounters this disease in clinical practice. In the present review, we aim to give a current overview of the manifestations and treatments relevant to the practicing rheumatologist. The most frequently encountered manifestation is Lofgren's syndrome, which is characterized by bilateral ankle periarthritis, bilateral hilar lymphadenopathy, and erythema nodosum and has an excellent prognosis. Chronic arthropathy most commonly manifests as oligoarthritis, which sometimes hampers its differentiation from spondylarthropathies, especially when sacroiliitis, enthesitis or dactylitis are simultaneously present. Isolated vertebral granulomas are rare and require infectious and malignant disorders to be excluded, since there are no specific imaging findings that are exclusively found in vertebral sarcoidosis. The presence of granulomas in skeletal muscle is common in muscle biopsies, whereas clinically overt myopathy is present in only around 1-2% of patients. Therapeutic responses vary among the different clinical phenotypes. Non-steroidal anti-inflammatory drugs and low to medium dose glucocorticoids are the first-line therapy for musculoskeletal manifestations and often lead to adequate disease control in acute sarcoidosis. When these are ineffective or not tolerated, steroid-sparing agents are increasingly used in chronic sarcoidosis. Evidence for all medications used in sarcoid-related arthritis is comparatively scant. When supplementing vitamin D, the possible development of hypercalcemia, even at standard doses, needs to be considered; the optimal therapeutic levels for the prevention of medication-induced osteoporosis in sarcoidosis have not been firmly established.
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Affiliation(s)
- P Korsten
- Klinik für Nephrologie und Rheumatologie, Universitätsmedizin Göttingen, Robert-Koch-Str. 40, 37075, Göttingen, Deutschland.
| | - G Chehab
- Poliklinik, Funktionsbereich und Hiller Forschungszentrum für Rheumatologie, Universitätsklinikum der Heinrich-Heine-Universität Düsseldorf, Düsseldorf, Deutschland
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19
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Kocak ND, Gungor S, Akturk UA, Yalcinsoy M, Kavas M, Oztas S, Akkaya ME, Aksoy E, Agca MC, Duman D, Karakurt Z. Analysis of Age Distribution and Disease Presentation of 1269 Patients with Sarcoidosis. Eurasian J Med 2017; 49:161-166. [PMID: 29123437 DOI: 10.5152/eurasianjmed.2017.17181] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Objective While the incidence of sarcoidosis peaks between 20 and 39 years, it is comparatively low in elderly subjects. We sought to determine whether there are age-dependent differences in the demographic and laboratory characteristics of patients with sarcoidosis. Materials and Methods We retrospectively collected information from our database using the International Classification of Disease (ICD) diagnostic code D86 between 2008 and 2014. Patients were divided into three groups: 20-39 years old (Group 1), 40-59 years old (Group 2), and 60-80 years old (Group 3). Results A total of 3988 patients with code of D86 were included in the study. After the exclusion of non-eligible patients, the number of cases in Groups 1, 2, and 3 were 276, 641, and 352, respectively. The groups were compared according to demographic characteristics, ICD diagnostic codes, and laboratory parameters. The ratio of female patients was significantly higher in Group 3 than in Groups 1 and 2 (p=0.000). There was no difference in diagnostic codes of the ICD subgroups between groups (p=0.19). While the level of blood-urea nitrogen was significantly higher in Group 3 patients than in other groups (p=0.000), serum angiotensin-converting enzyme (ACE) values were found to be significantly low in Group 3 (p=0.010). The mean ACE values did not differ between females and males (50.8±39.3 and 59.1±45.5 mg/dL, respectively) (p=0.18). Conclusion The majority of patients with sarcoidosis were female in all age groups and pulmonary sarcoidosis was the most common presentation of the disease. Elderly patients (≥60 years) with sarcoidosis had lower serum ACE levels than younger patients.
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Affiliation(s)
- Nagihan Durmus Kocak
- Pulmonary Diseases, University of Health Sciences, Süreyyapaşa Chest Diseases and Thoracic Surgery Education and Research Hospital, İstanbul, Turkey
| | - Sinem Gungor
- Pulmonary Diseases, University of Health Sciences, Süreyyapaşa Chest Diseases and Thoracic Surgery Education and Research Hospital, İstanbul, Turkey
| | - Ulku Aka Akturk
- Pulmonary Diseases, University of Health Sciences, Süreyyapaşa Chest Diseases and Thoracic Surgery Education and Research Hospital, İstanbul, Turkey
| | - Murat Yalcinsoy
- Pulmonary Diseases, University of Health Sciences, Süreyyapaşa Chest Diseases and Thoracic Surgery Education and Research Hospital, İstanbul, Turkey
| | - Murat Kavas
- Pulmonary Diseases, University of Health Sciences, Süreyyapaşa Chest Diseases and Thoracic Surgery Education and Research Hospital, İstanbul, Turkey
| | - Selahattin Oztas
- Pulmonary Diseases, University of Health Sciences, Süreyyapaşa Chest Diseases and Thoracic Surgery Education and Research Hospital, İstanbul, Turkey
| | - Mevhibe Esen Akkaya
- Pulmonary Diseases, University of Health Sciences, Süreyyapaşa Chest Diseases and Thoracic Surgery Education and Research Hospital, İstanbul, Turkey
| | - Emine Aksoy
- Pulmonary Diseases, University of Health Sciences, Süreyyapaşa Chest Diseases and Thoracic Surgery Education and Research Hospital, İstanbul, Turkey
| | - Meltem Coban Agca
- Pulmonary Diseases, University of Health Sciences, Süreyyapaşa Chest Diseases and Thoracic Surgery Education and Research Hospital, İstanbul, Turkey
| | - Dildar Duman
- Pulmonary Diseases, University of Health Sciences, Süreyyapaşa Chest Diseases and Thoracic Surgery Education and Research Hospital, İstanbul, Turkey
| | - Zuhal Karakurt
- Pulmonary Diseases, University of Health Sciences, Süreyyapaşa Chest Diseases and Thoracic Surgery Education and Research Hospital, İstanbul, Turkey
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20
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[Sarcoidosis and uveitis : An update]. Ophthalmologe 2016; 114:525-533. [PMID: 27904945 DOI: 10.1007/s00347-016-0405-7] [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: 10/20/2022]
Abstract
Ocular involvement in sarcoidosis is present in up to one third of patients and is frequently manifested before the underlying systemic disease has been diagnosed. With a view to the therapeutic consequences an early diagnosis of the underlying disease is advantageous. In cases of visual loss early diagnostic measures include invasive procedures, such as ultrasound-guided bronchoalveolar lavage and transbronchial biopsy, if nodular conjunctival or cutaneous manifestations which would confirm the diagnosis are not present. Sufficiently sensitive biomarkers of disease activity have not yet been identified. As elevated activity of angiotensin-converting enzyme (ACE) and lysozyme are associated with disease activity they may be supportive of but not specific for the diagnosis. Other indicators include calcemia, calciuria, augmented activity of hepatic enzymes, cutaneous anergy and hilar changes in the lungs. In patients with newly diagnosed anterior uveitis presenting with granulomatous mutton-fat corneal precipitates, snow balls and vitreous body base condensates with mild retinal periphlebitis in intermediate uveitis as well as multifocal choroiditis (creamy choroidal lesions at different stages of activity and approximately 500 µm in diameter), a diagnosis of sarcoidosis has to be considered and tuberculosis should be excluded, even in the absence of a known systemic disease. Anterior uveitis is frequently a self-limiting condition, which can be well-controlled with topical steroids. On the other hand, intermediate, posterior and panuveitis are typically associated with a chronic course and require systemic therapy to prevent severe loss of vision. If the response to systemic corticosteroids is insufficient, treatment with immunomodulatory agents and biologics is initiated at progressively earlier stages, with a view to averting permanent organ damage and frequently with a positive impact on the short and long-term outcomes, even in therapy-refractive cases.
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Ungprasert P, Crowson CS, Matteson EL. Influence of Gender on Epidemiology and Clinical Manifestations of Sarcoidosis: A Population-Based Retrospective Cohort Study 1976-2013. Lung 2016; 195:87-91. [PMID: 27709291 DOI: 10.1007/s00408-016-9952-6] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2016] [Accepted: 10/01/2016] [Indexed: 12/26/2022]
Abstract
PURPOSE The influence of ethnicity on epidemiology and clinical manifestations of sarcoidosis is well recognized. However, data on the role of sex are limited. METHODS The current study utilized the resource of the Rochester Epidemiology Project to identify all residents of Olmsted County, Minnesota, United States, with new diagnosis of sarcoidosis from 1976 to 2013. Diagnosis was verified by medical record and histopathological report review. RESULTS 345 incident cases of sarcoidosis were identified: 174 (50 %) were female and 171 (50 %) were male. The age at diagnosis was significantly higher among females than males (48.3 vs. 42.8 years; p < 0.001). Intra-thoracic disease was seen in the great majority of patients (98 % among females and 96 % among males; p = 0.50). However, pulmonary symptoms were significantly more frequent among males than females (51 vs. 36 %; p = 0.006). The frequency of individual extra-thoracic organ involvement was not significantly different between females and males except for cutaneous involvement and uveitis that were significantly more common among females (6 vs. 1 % for uveitis, p = 0.012 and 25 vs. 12 % for cutaneous involvement, p = 0.002). The frequency of elevate angiotensin-converting enzyme level and hypercalcemia was not significantly different between the two sexes. CONCLUSIONS Females tended to be older at the age they developed sarcoidosis, and had more uveitis and cutaneous involvement than males.
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Affiliation(s)
- Patompong Ungprasert
- Division of Rheumatology, Department of Internal Medicine, Mayo Clinic, 200 First avenue SW, Rochester, MN, 55905, USA.
| | - Cynthia S Crowson
- Division of Rheumatology, Department of Internal Medicine, Mayo Clinic, 200 First avenue SW, Rochester, MN, 55905, USA
- Division of Biomedical Statistics and Informatics, Department of Health Science Research, Mayo Clinic, Rochester, MN, 55905, USA
| | - Eric L Matteson
- Division of Rheumatology, Department of Internal Medicine, Mayo Clinic, 200 First avenue SW, Rochester, MN, 55905, USA
- Division of Epidemiology, Department of Health Science Research, Mayo Clinic, Rochester, MN, 55905, USA
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Radosavljević A, Jakšić V, Pezo L, Kovačević-Pavićević D, Ilić A, Mihailović Vučinić V. Clinical Features of Ocular Sarcoidosis in Patients with Biopsy-proven Pulmonary Sarcoidosis in Serbia. Ocul Immunol Inflamm 2016; 25:785-789. [DOI: 10.3109/09273948.2016.1167224] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- Aleksandra Radosavljević
- Clinic for Eye Diseases, Clinical Center of Serbia, Belgrade, Serbia
- University of Belgrade, School of Medicine, Belgrade, Serbia
| | - Vesna Jakšić
- University of Belgrade, School of Medicine, Belgrade, Serbia
| | - Lato Pezo
- Institute of General and Physical Chemistry, University of Belgrade, Belgrade, Serbia
| | - Dragana Kovačević-Pavićević
- Clinic for Eye Diseases, Clinical Center of Serbia, Belgrade, Serbia
- University of Belgrade, School of Medicine, Belgrade, Serbia
| | - Aleksandra Ilić
- Clinic for Eye Diseases, Clinical Center of Serbia, Belgrade, Serbia
| | - Violeta Mihailović Vučinić
- University of Belgrade, School of Medicine, Belgrade, Serbia
- Institute of Pulmonary Diseases, Clinical Center of Serbia, Belgrade, Serbia
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23
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Liu H, Patel D, Welch AM, Wilson C, Mroz MM, Li L, Rose CS, Van Dyke M, Swigris JJ, Hamzeh N, Maier LA. Association Between Occupational Exposures and Sarcoidosis: An Analysis From Death Certificates in the United States, 1988-1999. Chest 2016; 150:289-98. [PMID: 26836934 DOI: 10.1016/j.chest.2016.01.020] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2015] [Revised: 01/04/2016] [Accepted: 01/15/2016] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Sarcoidosis is a disease that is associated with occupational and environmental antigens, in the setting of a susceptible host. The aim of this study was to examine the association between sarcoidosis mortality and previously reported occupational exposures based on sex and race. METHODS The decedents enrolled in this study were derived from United States death certificates from 1988-1999. Cause of death was coded according to ICD-9 and ICD-10. The usual occupation was coded with Bureau of the Census Occupation Codes. Mortality odds ratio (MOR) were determined and multiple Poisson regression were performed to evaluate the independent exposure effects after adjustment for age, sex, race and other occupational exposures. RESULTS Of the 7,118,535 decedents in our study, 3,393 were identified as sarcoidosis-related, including 1,579 identified as sarcoidosis being the underlying cause of death. The sarcoidosis-related MOR of any occupational exposure was 1.52 (95% CI, 1.35-1.71). Women with any exposure demonstrated an increased MOR compared to women without (MOR 1.65, 95% CI, 1.45-1.89). The mortality risk was significantly elevated in those with employment involving metal working, health care, teaching, sales, banking, and administration. Higher sarcoidosis-related mortality risks associated with specific exposures were noted in women vs men and blacks vs whites. CONCLUSIONS Findings of prior occupations and risk of sarcoidosis were verified using sarcoidosis mortality rates. There were significant differences in risk for sarcoidosis mortality by occupational exposures based on sex and race.
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Affiliation(s)
- Hongbo Liu
- Division of Environmental and Occupational Health Sciences, National Jewish Health, Denver, CO; Department of Epidemiology and Biostatistics, China Medical University, Shenyang, China
| | - Divya Patel
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Florida, Gainesville, FL
| | - Alison M Welch
- Division of Environmental and Occupational Health Sciences, National Jewish Health, Denver, CO
| | - Carla Wilson
- Department of Biostatistics, National Jewish Health, Denver, CO
| | - Margaret M Mroz
- Division of Environmental and Occupational Health Sciences, National Jewish Health, Denver, CO
| | - Li Li
- Division of Environmental and Occupational Health Sciences, National Jewish Health, Denver, CO; Division of Pulmonary and Critical Care Sciences, Colorado School of Public Health, University of Colorado, Aurora, CO
| | - Cecile S Rose
- Division of Environmental and Occupational Health Sciences, National Jewish Health, Denver, CO; Division of Pulmonary and Critical Care Sciences, Colorado School of Public Health, University of Colorado, Aurora, CO; School of Medicine, and Environmental and Occupational Health, Colorado School of Public Health, University of Colorado, Aurora, CO
| | - Michael Van Dyke
- School of Medicine, and Environmental and Occupational Health, Colorado School of Public Health, University of Colorado, Aurora, CO
| | - Jeffrey J Swigris
- Pulmonary Division, National Jewish Health, Denver, CO; Division of Pulmonary and Critical Care Sciences, Colorado School of Public Health, University of Colorado, Aurora, CO
| | - Nabeel Hamzeh
- Division of Environmental and Occupational Health Sciences, National Jewish Health, Denver, CO; Division of Pulmonary and Critical Care Sciences, Colorado School of Public Health, University of Colorado, Aurora, CO
| | - Lisa A Maier
- Division of Environmental and Occupational Health Sciences, National Jewish Health, Denver, CO; Division of Pulmonary and Critical Care Sciences, Colorado School of Public Health, University of Colorado, Aurora, CO; School of Medicine, and Environmental and Occupational Health, Colorado School of Public Health, University of Colorado, Aurora, CO.
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Sarcoidosis of female reproductive organs in a postmenopausal woman: a case report and review of the literature: is there a potential for hormone therapy? Menopause 2016; 22:549-53. [PMID: 25314149 DOI: 10.1097/gme.0000000000000347] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
OBJECTIVE Sarcoidosis is a multisystem inflammatory disorder of unknown cause that affects multiple organs. To date, only isolated cases of extrapulmonary sarcoidosis of the female reproductive tract, which rarely affects postmenopausal women, have been reported. METHODS We describe the case of a postmenopausal woman with sarcoidosis of multiple structures of the genital tract accompanied by pulmonary involvement. A review of the literature was performed to examine the role of sex hormones in the pathogenesis of sarcoidosis. RESULTS We describe the case of a 60-year-old white, nulliparous, nulligravid postmenopausal woman with sarcoidosis of the cervix, uterus, mesosalpinx, and right ovary, accompanied by pulmonary involvement. The diagnosis was based on the identification of noncaseating granulomas in reproductive tract organs. Although imaging methods (high-resolution CT and chest x-ray) and pulmonary function tests did not reveal any abnormality, lung involvement was confirmed histologically by transbronchial biopsy. Treatment with steroids was successful and led to normalization of serum biomarker (serum angiotensin-converting enzyme, soluble interleukin-2 receptor, and neopterin) levels. CONCLUSIONS This particular case and a brief literature review of female genital tract sarcoidosis in postmenopausal women suggest the role of sex hormones in the pathogenesis of sarcoidosis. Hormone therapy may be a prospective therapeutic alternative to corticosteroids in postmenopausal women.
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25
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Abstract
Uveitides can be due to non-infectious and infectious etiologies. It has been observed that there is a gender difference with a greater preponderance of non-infectious uveitis in women than in men. This review will describe both non-infectious and infectious uveitides and describes some of the current autoimmune mechanisms thought to be underlying the gender difference. It will specifically look at non-infectious uveitides with systemic involvement including juvenile idiopathic arthritis, spondyloarthopathies, sarcoidosis, Behçet’s disease, and Vogt-Koyanagi-Harada disease and at uveitides without systemic involvement including sympathetic ophthalmia, birdshot chorioretinitis, and the white dot syndromes. Infectious uveitides like acute retinal necrosis, progressive outer retinal necrosis, and cytomegalovirus mediated uveitis will be mentioned. Different uveitides with female- or male- predominance are presented and discussed.
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