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Guliyeva V, Demirkan FG, Yiğit RE, Esen E, Bayındır Y, Torun R, Kılbas G, Gezgin Yıldırım D, Otar Yener G, Cakan M, Demir F, Özturk K, Baglan E, Yuksel S, Bakkaloglu SA, Bora Makay B, Paç Kısaarslan A, Oray M, Bilginer Y, Eker Ömeroğlu R, Ozen S, Sozeri B, Aktay Ayaz N. A clinical overview of paediatric sarcoidosis: Multicentre experience from Turkey. Mod Rheumatol 2024; 34:639-645. [PMID: 37243724 DOI: 10.1093/mr/road050] [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: 04/03/2023] [Revised: 04/29/2023] [Accepted: 05/25/2023] [Indexed: 05/29/2023]
Abstract
OBJECTIVES We aimed to outline the demographic data, clinical spectrum, and treatment approach of sarcoidosis in a large group of patients and sought to figure out the variations of early-onset (EOS) and late-onset paediatric sarcoidosis (LOS). METHODS The study followed a retrospective-descriptive design, with the analysis of medical records of cases diagnosed as paediatric sarcoidosis. RESULTS Fifty-two patients were included in the study. The median age at disease onset and follow-up duration were 83 (28.2-119) and 24 (6-48) months, respectively. Ten (19.2%) cases had EOS (before 5th birthday) and 42 (80.7%) cases had LOS. The most common clinical findings at the time of the disease onset were ocular symptoms (40.4%) followed by joint manifestation (25%), dermatological symptoms (13.5%), and features related to multi-organ involvement (11.5%). Anterior uveitis was the most common (55%) one among ocular manifestations. Patients with EOS displayed joint, eye, and dermatological findings more commonly than patients with LOS. The recurrence rate of disease in patients with EOS (5.7%) and LOS (21.1%) were not statistically different (P = .7). CONCLUSIONS Patients with EOS and LOS may present with variable clinical features and studies addressing paediatric sarcoidosis cases in collaboration between disciplines will enhance the awareness of this rare disease among physicians and assist early diagnosis with lesser complications.
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Affiliation(s)
- Vafa Guliyeva
- Department of Pediatric Rheumatology, Istanbul School of Medicine, Istanbul University, Istanbul, Türkiye
| | - Fatma Gul Demirkan
- Department of Pediatric Rheumatology, Istanbul School of Medicine, Istanbul University, Istanbul, Türkiye
| | - Ramazan Emre Yiğit
- Department of Pediatric Rheumatology, Ümraniye Research and Training Hospital, University of Health Science, Istanbul, Türkiye
| | - Esra Esen
- Department of Pediatric Rheumatology, Erciyes School of Medicine, Erciyes University, Kayseri, Türkiye
| | - Yagmur Bayındır
- Division of Pediatric Rheumatology, Hacettepe School of Medicine, Hacettepe University, Ankara, Türkiye
| | - Ruya Torun
- Division of Pediatric Rheumatology, Dokuz Eylül Faculty of Medicine, Dokuz Eylül University, İzmir, Türkiye
| | - Gulsah Kılbas
- Department of Pediatric Rheumatology, Pamukkale Faculty of Medicine, Pamukkale University, Denizli, Türkiye
| | - Deniz Gezgin Yıldırım
- Department of Pediatric Rheumatology, Gazi Faculty of Medicine, Gazi University, Ankara, Türkiye
| | - Gulcin Otar Yener
- Department of Pediatric Rheumatology, Sanliurfa Training and Research Hospital, Sanliurfa, Türkiye
| | - Mustafa Cakan
- Department of Pediatric Rheumatology, Ümraniye Research and Training Hospital, University of Health Science, Istanbul, Türkiye
| | - Ferhat Demir
- Department of Pediatric Rheumatology, Acibadem Hospital, Istanbul,Türkiye
| | - Kübra Özturk
- Department of Pediatric Rheumatology, Istanbul Medeniyet University, Göztepe Prof. Dr. Süleyman Yalçın City Hospital, Istanbul, Türkiye
| | - Esra Baglan
- Department of Pediatric Rheumatology, University of Health Sciences, Dr. Sami Ulus Maternity and Child Health and Diseases Research and Training Hospital, Ankara, Türkiye
| | - Selcuk Yuksel
- Department of Pediatric Rheumatology, Pamukkale Faculty of Medicine, Pamukkale University, Denizli, Türkiye
| | - Sevcan A Bakkaloglu
- Department of Pediatric Rheumatology, Gazi Faculty of Medicine, Gazi University, Ankara, Türkiye
| | - Balahan Bora Makay
- Division of Pediatric Rheumatology, Dokuz Eylül Faculty of Medicine, Dokuz Eylül University, İzmir, Türkiye
| | - Ayşenur Paç Kısaarslan
- Department of Pediatric Rheumatology, Erciyes School of Medicine, Erciyes University, Kayseri, Türkiye
| | - Merih Oray
- Department of Ophthalmology, Istanbul School of Medicine, Istanbul University, Istanbul, Türkiye
| | - Yelda Bilginer
- Division of Pediatric Rheumatology, Hacettepe School of Medicine, Hacettepe University, Ankara, Türkiye
| | - Rukiye Eker Ömeroğlu
- Department of Pediatric Rheumatology, Istanbul School of Medicine, Istanbul University, Istanbul, Türkiye
| | - Seza Ozen
- Division of Pediatric Rheumatology, Hacettepe School of Medicine, Hacettepe University, Ankara, Türkiye
| | - Betul Sozeri
- Department of Pediatric Rheumatology, Ümraniye Research and Training Hospital, University of Health Science, Istanbul, Türkiye
| | - Nuray Aktay Ayaz
- Department of Pediatric Rheumatology, Istanbul School of Medicine, Istanbul University, Istanbul, Türkiye
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Cozier YC, Arkema EV. Epidemiology of Sarcoidosis. Clin Chest Med 2024; 45:1-13. [PMID: 38245359 DOI: 10.1016/j.ccm.2023.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2024]
Abstract
Sarcoidosis is a systemic, granulomatous disease with variable presentation earning it the term "the great mimicker." The current epidemiology confirms that the disease occurs worldwide, affecting both sexes, and all races, ethnicities, and ages. To date, no causal exposure or agent has been identified. The organ systems most frequently affected by sarcoidosis are also those with greatest exposure to the natural world suggesting environmental and lifestyle contributions to the disease. These include particulate matter, microorganisms, nicotine, and obesity. In this article, we review the epidemiology of sarcoidosis and discuss these non-genetic risk factors in the hope of providing important insight into sarcoidosis and stimulating future research.
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Affiliation(s)
- Yvette C Cozier
- Department of Epidemiology, Boston University School of Public Health, 715 Albany Street, Talbot 3-East, Boston, MA 02118-2526, USA.
| | - Elizabeth V Arkema
- Department of Medicine Solna, Division of Clinical Epidemiology, Karolinska Institutet, T2, Stockholm 17176, Sweden
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Abstract
Sarcoidosis is characterized by noncaseating granulomas which form in almost any part of the body, primarily in the lungs and/or thoracic lymph nodes. Environmental exposures in genetically susceptible individuals are believed to cause sarcoidosis. There is variation in incidence and prevalence by region and race. Males and females are almost equally affected, although disease peaks at a later age in females than in males. The heterogeneity of presentation and disease course can make diagnosis and treatment challenging. Diagnosis is suggestive in a patient if one or more of the following is present: radiologic signs of sarcoidosis, evidence of systemic involvement, histologically confirmed noncaseating granulomas, sarcoidosis signs in bronchoalveolar lavage fluid (BALF), and low probability or exclusion of other causes of granulomatous inflammation. No sensitive or specific biomarkers for diagnosis and prognosis exist, but there are several that can be used to support clinical decisions, such as serum angiotensin-converting enzyme levels, human leukocyte antigen types, and CD4 Vα2.3+ T cells in BALF. Corticosteroids remain the mainstay of treatment for symptomatic patients with severely affected or declining organ function. Sarcoidosis is associated with a range of adverse long-term outcomes and complications, and with great variation in prognosis between populations. New data and technologies have moved sarcoidosis research forward, increasing our understanding of the disease. However, there is still much left to be discovered. The pervading challenge is how to account for patient variability. Future studies should focus on how to optimize current tools and develop new approaches so that treatment and follow-up can be targeted to individuals with more precision.
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Affiliation(s)
- Marios Rossides
- Department of Respiratory Medicine and Allergy, Theme Inflammation and Ageing, Karolinska University Hospital, Stockholm, Sweden.,Unit of Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Pernilla Darlington
- Department of Clinical Science and Education, Södersjukhuset and Karolinska Institutet, Stockholm, Sweden.,Department of Internal Medicine, Södersjukhuset, Stockholm, Sweden
| | - Susanna Kullberg
- Department of Respiratory Medicine and Allergy, Theme Inflammation and Ageing, Karolinska University Hospital, Stockholm, Sweden.,Department of Medicine Solna, Respiratory Medicine Division & Center for Molecular Medicine (CMM), Karolinska Institutet, Stockholm, Sweden
| | - Elizabeth V Arkema
- Department of Medicine Solna, Clinical Epidemiology Division, Karolinska Institutet, Stockholm, Sweden
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Abstract
INTRODUCTION Sarcoidosis is a systemic granulomatous disease of unknown etiology, primarily affecting the lungs and thoracic lymph nodes. Fatigue is a frequent and disabling symptom in sarcoidosis with a significant impact on quality of life. In Denmark, the incidence of sarcoidosis has increased; however, the extent and risk factors of fatigue have not been investigated and no recent reports of the characteristics of patients with sarcoidosis in Denmark exist. AIM To assess the frequency of fatigue in patients with sarcoidosis in Denmark at diagnosis and to investigate if fatigue correlated with relevant disease parameters. Moreover, to characterize patients with sarcoidosis in Denmark at time of diagnosis. METHODS Data were collected in 150 patients with recently diagnosed sarcoidosis. Fatigue was measured using the Fatigue Assessment Scale (FAS). Patients with fatigue were compared to non-fatigue patients regarding clinical parameters. RESULTS FAS was completed by 145 of 150 patients. Fifty-one percent reported significant fatigue. Mean FAS score was 23.6 and 51% had a FAS score ≥ 22. Fatigue in 89 incident patients did not correlate significantly with demographics, physiological, or clinical parameters. Fifty-nine percent were males. Mean age was 47 years; mean values (% predicted) for pulmonary function tests were normal and 71% at Scadding stage 0-I. CONCLUSION In Denmark, fatigue was frequent in patients with sarcoidosis. The majority of patients had mild disease at diagnosis and were older but lower at Scadding stage at diagnosis compared to previous cohorts.
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Garret M, Pestronk A. Sarcoidosis, granulomas and myopathy syndromes: A clinical-pathology review. J Neuroimmunol 2022; 373:577975. [PMID: 36228383 DOI: 10.1016/j.jneuroim.2022.577975] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2022] [Revised: 09/24/2022] [Accepted: 09/29/2022] [Indexed: 11/29/2022]
Abstract
Muscle involvement in sarcoidosis is common by pathologic analysis, but symptomatic disorders are less frequent. Sarcoidosis-related muscle pathology includes non-caseating granulomas, muscle fiber changes that are diffuse or anatomically related to granulomas, and perimysial connective tissue with histiocyte-associated damage. The mechanisms by which granulomas form, enlarge and damage muscle tissues are incompletely understood. Sarcoidosis-related clinical syndromes with muscle involvement include: chronic myopathies with proximal weakness; nodular disorders; subacute onset disorders involving proximal or eye muscles; myalgia or fatigue syndromes; and, possibly, inclusion body myositis-like disorders. Corticosteroid treatment may benefit some syndromes, but clinical trials are necessary.
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Affiliation(s)
- Mark Garret
- Departments of Neurology, Washington University School of Medicine, Saint Louis, MO, USA
| | - Alan Pestronk
- Departments of Neurology, Washington University School of Medicine, Saint Louis, MO, USA; Pathology and Immunology, Washington University School of Medicine, Saint Louis, MO, USA.
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Cohen Tervaert JW, van Eeden C, Osman M. Response to letter to the editor: Bradford Hill and breast implant illness: evidence for a causal association with breast implants. Expert Rev Clin Immunol 2022; 18:777-778. [PMID: 35713685 DOI: 10.1080/1744666x.2022.2090340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
| | - Charmaine van Eeden
- Division of Rheumatology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Mohammed Osman
- Division of Rheumatology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
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