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Judson MA. Cough monitoring for pulmonary sarcoidosis. Respir Med 2024; 221:107483. [PMID: 38113960 DOI: 10.1016/j.rmed.2023.107483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 11/28/2023] [Indexed: 12/21/2023]
Affiliation(s)
- Marc A Judson
- Division of Pulmonary and Critical Care Medicine, MC-91, Albany Medical College, Albany, NY 12208, USA.
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Judson MA. The Symptoms of Pulmonary Sarcoidosis. J Clin Med 2023; 12:6088. [PMID: 37763028 PMCID: PMC10532418 DOI: 10.3390/jcm12186088] [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: 08/24/2023] [Revised: 09/12/2023] [Accepted: 09/15/2023] [Indexed: 09/29/2023] Open
Abstract
The aim of this manuscript is to provide a comprehensive review of the etiology, measurement, and treatment of common pulmonary symptoms associated with sarcoidosis. The assessment of symptoms associated with pulmonary sarcoidosis is an important component of disease management. Some symptoms of pulmonary sarcoidosis are sensitive but nonspecific markers of disease activity, and the absence of such symptoms provides evidence that the disease is quiescent. Although quantifiable objective measurements of pulmonary physiology and chest imaging are important in the assessment of pulmonary sarcoidosis, they correlate poorly with the patient's quality of life. Because the symptoms of pulmonary sarcoidosis directly relate to how the patient feels, they are reasonable endpoints in terms of clinical research and individual patient care. Recently, the symptoms of pulmonary sarcoidosis are capable of being quantified via patient-reported outcome measures and electronic devices. We conclude that a thorough assessment of the symptoms associated with pulmonary sarcoidosis improves patient care because it is a useful screen for manifestations of the disease, provides insight into the pathophysiology of manifestations of sarcoidosis, and may assist in optimizing treatment.
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Affiliation(s)
- Marc A Judson
- Division of Pulmonary and Critical Care Medicine, Albany Medical College, Albany, NY 12208, USA
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Judson MA. The management of sarcoidosis in the 2020's by the primary care physician. Am J Med 2023; 136:534-544. [PMID: 36889493 DOI: 10.1016/j.amjmed.2023.02.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 02/20/2023] [Accepted: 02/20/2023] [Indexed: 03/08/2023]
Abstract
Sarcoidosis is an idiopathic granulomatous disease that occurs worldwide and may affect any organ. Because the presenting symptoms of sarcoidosis are not specific for the disease, the primary care physician is usually the first provider to assess these patients. In addition, patients who have previously been diagnosed with sarcoidosis are usually followed longitudinally by primary care physicians. Therefore, these physicians are often the first to address sarcoidosis patient symptoms related to exacerbations of the disease, as well as first observe complications of sarcoidosis medications. This article outlines the approach to the evaluation, treatment and monitoring of sarcoidosis patients by the primary care physician.
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Affiliation(s)
- Marc A Judson
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Albany Medical College, 16 New Scotland Avenue, Albany, New York 12208 USA.
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Casal A, Suárez-Antelo J, Soto-Feijóo R, Ferreiro L, Rodríguez-Núñez N, Lama A, Riveiro V, Toubes ME, Lourido T, Ricoy J, Rábade C, Zamarrón C, Rodríguez C, Abelleira R, Álvarez-Dobaño JM, Golpe A, de Alegría AM, Antúnez JR, Gude F, Valdés L. Sarcoidosis. Disease progression based on radiological and functional course: Predictive factors. Heart Lung 2022; 56:62-69. [PMID: 35780571 DOI: 10.1016/j.hrtlng.2022.06.020] [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: 03/27/2022] [Revised: 06/20/2022] [Accepted: 06/22/2022] [Indexed: 11/04/2022]
Abstract
BACKGROUND Sarcoidosis is a multiorgan granulomatous disease with a variable course. OOBJECTIVES The purpose of this study is to identify the patients that are more likely to experience disease progression. METHODS A retrospective study in patients ≥18 years. Pulmonary function and radiological stage (Scadding criteria) were assessed at diagnosis, and at 1, 3 and 5 years. Sarcoidosis progression was established based on deterioration of radiological or pulmonary function (decrease ≥10% of FVC and/or ≥15% of diffusing capacity of the lung (DLCO). RESULTS The sample included 277 caucasian patients [mean age, 50±13.6; 69.7% between 31-60 years; 56.3% men]. In total, 65% had stage II sarcoidosis, whereas only 8.3% had stage III/IV disease. Mean pulmonary function (FVC, FEV1, FEV1/FVC and DLCO) at diagnosis was 103±21.8, 96±22.2, 76.2±8 and 81.7±21.7, respectively. The percentage of patients with normal FVC and DLCO was 72.2% and 51.8%, respectively. Radiological stage did not change significantly during follow-up (5 years; p=0.080) and only progressed in 13 patients (5.7%). At 3 years, FVC improved, whereas DLCO exacerbated significantly (p<0.001 for the two). Disease progressed in 34.5% of the patients (57/165) whose pulmonary function and radiological stage were available (both baseline and at 3 years). Age was associated with disease progression [OR=1.04 (95%CI=1.01, 1.06)]. Risk increased by 4% for each year older a patient was at diagnosis. CONCLUSIONS At 3 years, a third of patients experienced sarcoidosis progression. Age was the only factor associated with disease prognosis.
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Affiliation(s)
- Ana Casal
- Pneumology Department, Hospital Clínico Universitario, Santiago de Compostela, Spain.
| | - Juan Suárez-Antelo
- Pneumology Department, Hospital Clínico Universitario, Santiago de Compostela, Spain
| | - Roi Soto-Feijóo
- Pneumology Department, Hospital Clínico Universitario, Santiago de Compostela, Spain.
| | - Lucía Ferreiro
- Pneumology Department, Hospital Clínico Universitario, Santiago de Compostela, Spain; Health Research Institute (IDIS), Santiago de Compostela, Spain.
| | - Nuria Rodríguez-Núñez
- Pneumology Department, Hospital Clínico Universitario, Santiago de Compostela, Spain.
| | - Adriana Lama
- Pneumology Department, Hospital Clínico Universitario, Santiago de Compostela, Spain.
| | - Vanessa Riveiro
- Pneumology Department, Hospital Clínico Universitario, Santiago de Compostela, Spain.
| | - Mª Elena Toubes
- Pneumology Department, Hospital Clínico Universitario, Santiago de Compostela, Spain.
| | - Tamara Lourido
- Pneumology Department, Hospital Clínico Universitario, Santiago de Compostela, Spain.
| | - Jorge Ricoy
- Pneumology Department, Hospital Clínico Universitario, Santiago de Compostela, Spain.
| | - Carlos Rábade
- Pneumology Department, Hospital Clínico Universitario, Santiago de Compostela, Spain.
| | - Carlos Zamarrón
- Pneumology Department, Hospital Clínico Universitario, Santiago de Compostela, Spain.
| | - Carlota Rodríguez
- Pneumology Department, Hospital Clínico Universitario, Santiago de Compostela, Spain.
| | - Romina Abelleira
- Pneumology Department, Hospital Clínico Universitario, Santiago de Compostela, Spain.
| | - José Manuel Álvarez-Dobaño
- Pneumology Department, Hospital Clínico Universitario, Santiago de Compostela, Spain; Health Research Institute (IDIS), Santiago de Compostela, Spain.
| | - Antonio Golpe
- Pneumology Department, Hospital Clínico Universitario, Santiago de Compostela, Spain; Health Research Institute (IDIS), Santiago de Compostela, Spain.
| | | | - José Ramón Antúnez
- Anatomical Pathology Department, Hospital Clínico Universitario, Santiago de Compostela, Spain.
| | - Francisco Gude
- Health Research Institute (IDIS), Santiago de Compostela, Spain; Clinical Epidemiology Unit, Hospital Clínico Universitario, Santiago de Compostela, Spain.
| | - Luis Valdés
- Pneumology Department, Hospital Clínico Universitario, Santiago de Compostela, Spain; Health Research Institute (IDIS), Santiago de Compostela, Spain; University of Santiago de Compostela.
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Rabahoğlu B, Oymak FS, Baran Ketencioğlu B, Tutar N, Gülmez İ, Yılmaz İ. Frequency of peripheral blood eosinophilia and obstructive airway disease in sarcoidosis. Turk J Med Sci 2021; 51:3001-3007. [PMID: 36161645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Accepted: 11/04/2021] [Indexed: 06/16/2023] Open
Abstract
BACKGROUND There is limited information about peripheral blood eosinophilia (PBE) and airway obstruction in sarcoidosis. Since pulmonary sarcoidosis affects the airways, it is often confused with asthma. The aims of the study are to investigate airway obstruction and PBE in sarcoidosis patients and to examine the similarity of clinical presentation with asthma. METHODS The patients matching the ATS/ERS/WASOG diagnosis criteria and were between 18 and 80 years of age were included consecutively between 2018 and 2020. Other diseases causing granulomas were excluded. RESULTS A total of 84 patients were included of which 26 (31%) had a PBE level of ≥300 µL with no significant difference seen between sarcoidosis stage and PBE (p > 0.05). A significant (p < 0.05) decrease was only seen in FEV1 as the stage of sarcoidosis progressed. Respectively 31 (36.9%), 12 (14.3%) and 4 (4.8%) patients had an obstructive, restrictive and mixed respiratory function disorder. Twenty-four (28.6%) subjects with sarcoidosis had history of asthma. Spring fever, eczema, and skin/nose allergy were noticed in 17 (20.2%) of the patients. DISCUSSION Mild PBE may be seen in sarcoidosis. Patients applying with PBE, airway obstruction, bronchial hyperreactivity along with spring fever, eczema, skin/nose allergy, wheezing, chest tightness, shortness of breath and cough may be also evaluated in terms of sarcoidosis.
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Affiliation(s)
- Bilal Rabahoğlu
- Department of Pulmonary Medicine, School of Medicine, Erciyes University, Kayseri, Turkey
| | - Fatma Sema Oymak
- Department of Pulmonary Medicine, School of Medicine, Erciyes University, Kayseri, Turkey
| | | | - Nuri Tutar
- Department of Pulmonary Medicine, School of Medicine, Erciyes University, Kayseri, Turkey
| | - İnci Gülmez
- Department of Pulmonary Medicine, School of Medicine, Erciyes University, Kayseri, Turkey
| | - İnsu Yılmaz
- Division of Immunology and Allergy, Department of Pulmonary Medicine, School of Medicine, Erciyes University, Kayseri, Turkey
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Gupta R, Judson MA, Baughman RP. Management of Advanced Pulmonary Sarcoidosis. Am J Respir Crit Care Med 2021; 205:495-506. [PMID: 34813386 DOI: 10.1164/rccm.202106-1366ci] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The term "advanced sarcoidosis" is used for forms of sarcoidosis with a significant risk of loss of organ function or death. Advanced sarcoidosis often involves the lung and is described as "Advanced Pulmonary Sarcoidosis" (APS) which includes advanced pulmonary fibrosis, associated complications such as bronchiectasis and infections, and pulmonary hypertension. While APS affects a small proportion of patients with sarcoidosis, it is the leading cause of poor outcomes including death. Herein we review the major patterns of APS with a focus on the current management as well as potential approaches for improved outcomes for this most serious sarcoidosis phenotype.
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Affiliation(s)
- Rohit Gupta
- Temple University School of Medicine, 12314, Thoracic Medicine and Surgery, Philadelphia, Pennsylvania, United States;
| | - Marc A Judson
- Albany Medical College, 1092, Division of Pulmonary and Critical Care Medicine, Albany, New York, United States
| | - Robert P Baughman
- University of Cincinnati Medical Center, 24267, Medicine, Cincinnati, Ohio, United States
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Judson MA. Granulomatous Sarcoidosis Mimics. Front Med (Lausanne) 2021; 8:680989. [PMID: 34307411 PMCID: PMC8295651 DOI: 10.3389/fmed.2021.680989] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 06/10/2021] [Indexed: 12/19/2022] Open
Abstract
Many granulomatous diseases can mimic sarcoidosis histologically and in terms of their clinical features. These mimics include infectious granulomatous diseases, granulomatous reactions to occupational and environmental exposures, granulomatous drug reactions, vasculitides and idiopathic granulomatous conditions. It is important to distinguish sarcoidosis from these mimics, as a misdiagnosis of these diseases may have serious consequences. This manuscript reviews numerous sarcoidosis mimics and describes features of these diseases that may allow them to be differentiated from sarcoidosis. Distinguishing features between sarcoidosis and its mimics requires a careful review of the medical history, symptoms, demographics, radiographic findings, histologic features, and additional laboratory data. Understanding the clinical characteristics of sarcoidosis and its mimics should lead to more accurate diagnoses and treatment of granulomatous disorders that should improve the care of these patients. As the diagnostic criteria of sarcoidosis are not standardized, it is possible that some of these sarcoidosis mimics may represent varied clinical presentations of sarcoidosis itself.
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Affiliation(s)
- Marc A Judson
- Division of Pulmonary and Critical Care Medicine MC-91, Department of Medicine, Albany, NY, United States
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Challenges in Cardiac and Pulmonary Sarcoidosis: JACC State-of-the-Art Review. J Am Coll Cardiol 2021; 76:1878-1901. [PMID: 33059834 DOI: 10.1016/j.jacc.2020.08.042] [Citation(s) in RCA: 110] [Impact Index Per Article: 36.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Revised: 08/12/2020] [Accepted: 08/13/2020] [Indexed: 12/17/2022]
Abstract
Sarcoidosis is a complex disease with heterogeneous clinical presentations that can affect virtually any organ. Although the lung is typically the most common organ involved, combined pulmonary and cardiac sarcoidosis (CS) account for most of the morbidity and mortality associated with this disease. Pulmonary sarcoidosis can be asymptomatic or result in impairment in quality of life and end-stage, severe, and/or life-threatening disease. The latter outcome is seen almost exclusively in those with fibrotic pulmonary sarcoidosis, which accounts for 10% to 20% of pulmonary sarcoidosis patients. CS is problematic to diagnose and may cause significant morbidity and death from heart failure or ventricular arrhythmias. The diagnosis of CS usually requires surrogate cardiac imaging biomarkers, as endomyocardial biopsy has relatively low yield, even with directed electrophysiological mapping. Treatment of CS is often multifactorial, involving a combination of antigranulomatous therapy and pharmacotherapy for cardiac arrhythmias and/or heart failure in addition to device placement and cardiac transplantation.
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Abstract
As sarcoidosis may involve any organ, sarcoidosis patients should be evaluated for occult disease. Screening for some organ involvement may not be warranted if it is unlikely to cause symptoms, organ dysfunction, or affect clinical outcome. Even organ involvement that affects clinical outcome does not necessarily require screening if early detection fails to change the patient's quality of life or prognosis. On the other hand, early detection of some forms of sarcoidosis may improve outcomes and survival. This manuscript describes the approach to screening sarcoidosis patients for previously undetected disease. Screening for sarcoidosis should commence with a meticulous medical history and physical examination. Many sarcoidosis patients present with physical signs or symptoms of sarcoidosis that have not been recognized as manifestations of the disease. Detection of sarcoidosis in these instances depends on the clinician's familiarity with the varied clinical presentations of sarcoidosis. In addition, sarcoidosis patients may present with symptoms or signs that are not related to specific organ involvement that have been described as parasarcoidosis syndromes. It is conjectured that parasarcoidosis syndromes result from systemic release of inflammatory mediators from the sarcoidosis granuloma. Certain forms of sarcoidosis may cause permanent and serious problems that can be prevented if they are detected early in the course of their disease. These include (1) ocular involvement that may lead to permanent vision impairment; (2) vitamin D dysregulation that may lead to hypercalcemia, nephrolithiasis, and permanent kidney injury; and (3) cardiac sarcoidosis that may lead to a cardiomyopathy, ventricular arrhythmias, heart block, and sudden death. Screening for these forms of organ involvement requires detailed screening approaches.
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Affiliation(s)
- Marc A Judson
- Division of Pulmonary and Critical Care Medicine, Albany Medical College, Albany, New York
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Khawaja A, Kotloff R. A 31-Year-Old Man With Airflow Obstruction, Intrathoracic Adenopathy, and Pulmonary Nodules. Chest 2019; 155:e55-e59. [PMID: 30732704 DOI: 10.1016/j.chest.2018.08.1038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Revised: 08/09/2018] [Accepted: 08/16/2018] [Indexed: 11/15/2022] Open
Abstract
CASE PRESENTATION A 31-year-old white man presented for evaluation of productive cough and dyspnea on exertion of 2 months' duration. Associated symptoms included wheezing, chest tightness, and postnasal drip. He was recently treated for pneumonia with a 7-day course of levofloxacin because of an abnormal chest radiograph demonstrating bilateral infiltrates, but his symptoms failed to improve. He had a medical history of mild intermittent asthma and was on no active treatment. He was a nonsmoker. He was born in the United States. He denied any recent travel within or outside the United States, sick contacts, or illicit drug use. He did not have any pets and denied exposure to mold, hot tubs, a down comforter, or pillows. He worked in a vocational program and his hobbies included refinishing wood floors.
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Affiliation(s)
- Ali Khawaja
- Department of Internal Medicine, Cleveland Clinic, Cleveland, OH.
| | - Robert Kotloff
- Department of Pulmonary Medicine, Cleveland Clinic, Cleveland, OH
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Abstract
Sarcoidosis is a highly variable granulomatous multisystem syndrome. It affects individuals in the prime years of life; both the frequency and severity of sarcoidosis are greater in economically disadvantaged populations. The diagnosis, assessment, and management of pulmonary sarcoidosis have evolved as new technologies and therapies have been adopted. Transbronchial needle aspiration guided by endobronchial ultrasound has replaced mediastinoscopy in many centers. Advanced imaging modalities, such as fluorodeoxyglucose positron emission tomography scanning, and the widespread availability of magnetic resonance imaging have led to more sensitive assessment of organ involvement and disease activity. Although several new insights about the pathogenesis of sarcoidosis exist, no new therapies have been specifically developed for use in the disease. The current or proposed use of immunosuppressive medications for sarcoidosis has been extrapolated from other disease states; various novel pathways are currently under investigation as therapeutic targets. Coupled with the growing recognition of corticosteroid toxicities for managing sarcoidosis, the use of corticosteroid sparing anti-sarcoidosis medications is likely to increase. Besides treatment of granulomatous inflammation, recognition and management of the non-granulomatous complications of pulmonary sarcoidosis are needed for optimal outcomes in patients with advanced disease.
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Affiliation(s)
- Daniel A Culver
- Department of Pulmonary Medicine, Respiratory Institute, Department of Inflammation and Immunity, Lerner Research Institute Cleveland Clinic, Cleveland, OH, USA
| | - Marc A Judson
- Division of Pulmonary and Critical Care Medicine, Albany Medical College, Albany, NY, USA
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Marshall GD. Challenges in allergy immunology practice: Solutions needed for persistent patient problems. Ann Allergy Asthma Immunol 2019; 121:647-648. [PMID: 30502819 DOI: 10.1016/j.anai.2018.10.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Accepted: 10/17/2018] [Indexed: 11/18/2022]
Affiliation(s)
- Gailen D Marshall
- Editor-in-Chief, Annals of Allergy, Asthma and Immunology, Department of Medicine, Division of Clinical Immunology and Allergy, Laboratory of Behavioral Immunology Research, The University of Mississippi Medical Center, Jackson, Mississippi.
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Ujino M, Miyoshi S, Sugimoto N, Arai H, Ota Y, Sasajima Y, Kawamura M, Nagase H, Yamaguchi M, Ohta K. Methotrexate-associated Lymphoproliferative Disorder: A Rare Differential Diagnosis of Wheezes. Intern Med 2019; 58:1759-1764. [PMID: 30713294 PMCID: PMC6630116 DOI: 10.2169/internalmedicine.2080-18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
A 70-year-old woman was admitted for the evaluation of wheezes and a nodular lesion in the left lung field. She had been diagnosed with rheumatoid arthritis at 45 years of age and was continuously treated with methotrexate (MTX) at 8 mg/week. Bronchoscopic aspiration histology of a hilar lymph node suggested a lymphoproliferative disorder (LPD). After discontinuation of MTX, the lung nodule and wheezes disappeared. Although wheezes are not a usual manifestation of LPD, her clinical course clearly demonstrated an obvious relationship between LPD-induced airway narrowing and wheezes.
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Affiliation(s)
- Mariko Ujino
- Division of Respiratory Medicine and Allergology, Department of Medicine, Teikyo University School of Medicine, Japan
| | - Shoki Miyoshi
- Division of Respiratory Medicine and Allergology, Department of Medicine, Teikyo University School of Medicine, Japan
| | - Naoya Sugimoto
- Division of Respiratory Medicine and Allergology, Department of Medicine, Teikyo University School of Medicine, Japan
| | - Hidenori Arai
- Division of Respiratory Medicine and Allergology, Department of Medicine, Teikyo University School of Medicine, Japan
| | - Yasunori Ota
- Department of Pathology, Teikyo University School of Medicine, Japan
- Department of Pathology, Teikyo University Hospital, Japan
| | - Yuko Sasajima
- Department of Pathology, Teikyo University School of Medicine, Japan
- Department of Pathology, Teikyo University Hospital, Japan
| | | | - Hiroyuki Nagase
- Division of Respiratory Medicine and Allergology, Department of Medicine, Teikyo University School of Medicine, Japan
| | - Masao Yamaguchi
- Division of Respiratory Medicine and Allergology, Department of Medicine, Teikyo University School of Medicine, Japan
| | - Ken Ohta
- Division of Respiratory Medicine and Allergology, Department of Medicine, Teikyo University School of Medicine, Japan
- JATA Fukujuji Hospital, Japan
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Kovacova E, Buday T, Vysehradsky R, Plevkova J. Cough in sarcoidosis patients. Respir Physiol Neurobiol 2018; 257:18-24. [DOI: 10.1016/j.resp.2018.01.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2017] [Revised: 12/23/2017] [Accepted: 01/03/2018] [Indexed: 02/06/2023]
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Abstract
Sarcoidosis has innumerable clinical manifestations, as the disease may affect every body organ. Furthermore, the severity of sarcoidosis involvement may range from an asymptomatic state to a life-threatening condition. This manuscript reviews a wide variety of common and less common clinical characteristics of sarcoidosis. These manifestations are presented organ by organ, although additional sections describe systemic and multiorgan presentations of sarcoidosis. The lung is the organ most commonly involved with sarcoidosis with at least 90 % of sarcoidosis patients demonstrating lung involvement in most series. The skin, eye, liver, and peripheral lymph node are the next most commonly clinically involved organs in most series, with the frequency of involvement ranging from 10 to 30 %. The actual frequency of sarcoidosis organ involvement is probably much higher as it is frequently asymptomatic and may avoid detection. This is particularly common with lung, liver, cardiac, and bone involvement. Cardiac sarcoidosis is present in 25 % of all sarcoidosis but only causes clinical problems in 5 % of them. Nevertheless, unlike sarcoidosis involvement of most other organs, it may be suddenly fatal. Therefore, it is important to screen for cardiac sarcoidosis in all sarcoidosis patients. All sarcoidosis patients should also be screened for eye involvement as asymptomatic patients may have eye involvement that may cause permanent vision impairment. Pulmonary fibrosis from sarcoidosis is usually slowly progressive but may be life-threatening because of the development of respiratory failure, pulmonary hypertension, or hemoptysis related to a mycetoma or bronchiectasis. Some manifestations of sarcoidosis are not organ-specific and probably are the result of a release of mediators from the sarcoid granuloma. Two such manifestations include small fiber neuropathy and fatigue syndromes, and they are observed in a large percentage of patients.
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Abstract
PURPOSE OF REVIEW Despite the frequent occurrence of worsening pulmonary symptoms in pulmonary sarcoidosis patients, there is little available information concerning this topic. RECENT FINDINGS In this review, we outline the various causes for these symptoms. We propose to partition the various causes for these symptoms into specific categories. SUMMARY We believe that these categories will provide the clinician a framework to evaluate pulmonary sarcoidosis patients with such symptoms in a rigorous way that may be useful in optimizing their care.
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Mentzer A, Goel R, Elliott T, Campbell H, Hullah E, Patel P, Challacombe S, Escudier M, Sanderson JD. Azathioprine is effective for oral involvement in Crohn's disease but not for orofacial granulomatosis alone. J Oral Pathol Med 2015; 45:312-8. [DOI: 10.1111/jop.12379] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/15/2015] [Indexed: 12/11/2022]
Affiliation(s)
- A. Mentzer
- Department of Gastroenterology; Guy's and St. Thomas' NHS Foundation Trust and King's College; London UK
| | - R. Goel
- Department of Gastroenterology; Guy's and St. Thomas' NHS Foundation Trust and King's College; London UK
| | - T. Elliott
- Department of Gastroenterology; Guy's and St. Thomas' NHS Foundation Trust and King's College; London UK
| | - H. Campbell
- Department of Nutrition; Guy's and St. Thomas' NHS Foundation Trust and King's College; London UK
| | - E. Hullah
- Department of Oral Medicine and Pathology; Guy's and St. Thomas' NHS Foundation Trust and King's College; London UK
| | - P. Patel
- Department of Gastroenterology; Guy's and St. Thomas' NHS Foundation Trust and King's College; London UK
| | - S. Challacombe
- Department of Oral Medicine and Pathology; Guy's and St. Thomas' NHS Foundation Trust and King's College; London UK
| | - M. Escudier
- Department of Oral Medicine and Pathology; Guy's and St. Thomas' NHS Foundation Trust and King's College; London UK
| | - J. D. Sanderson
- Department of Gastroenterology; Guy's and St. Thomas' NHS Foundation Trust and King's College; London UK
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Abstract
Sarcoidosis is an idiopathic inflammatory disorder characterized by noncaseating granulomas, which can affect any organ system. The lungs are most commonly affected but extrapulmonary sites may cause the initial and/or sole symptoms. In this review, the disease manifestations and treatment are described, with particular emphasis on the management of each affected organ system. Diagnosis and management can be difficult and greatly affect quality of life, but despite these challenges, it is possible to successfully manage patients with sarcoidosis in the primary care setting.
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Affiliation(s)
- Justin Shinn
- Department of Internal Medicine, University of Washington School of Medicine, 1959 NE Pacific Street, Seattle, WA 98115, USA.
| | - Douglas S Paauw
- Division of General Internal Medicine, Department of Medicine, University of Washington School of Medicine, 1959 NE Pacific Street, Seattle, WA 98195, USA
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