Current diagnosis and therapy in sarcoidosis

Czech version

Authors: Martina Šterclová
Authors‘ workplace: Pneumologická klinika 1. LF UK a Thomayerovy nemocnice, Praha ; Pneumologická klinika 2. LF UK a FN Motol, Praha
Published in: Vnitř Lék 2020; 66(7): 409-413
Category:

Overview

Sarcoidosis is a disorder of unknown etiology, that may affect any organ in human body, most often lungs and lymph nodes. New diagnostic guidelines and new treatment recommendations were recently published. Since differential diagnosis of sarcoidosis is broad, diagnostic algorithm has to be complex. Diagnosis needs to be confirmed before initiation of any any treatment regimen – it is a severe mistake to start treatment before confirmation of diagnosis (histologic pattern of epitheloid non necrotising granuloma, exclusion of other possible causes of granulomatous diseases, exclusive situations mentioned in the article body). Not every patient with sarcoidosis needs pharmacologic treatment. Treatment decision should involve extent of involvement, risk of damage of affected organs and patient symptoms. While in patients with Löfgren syndrome both histologic verification and systemic corticotherapy is not needed (systemic corticotherapy should be avoided), pharmacologic treatment is necessary in patients with myocardial involvement.

Keywords:

sarcoidosis – diagnosis – therapy – granuloma

Sources

1. Culver DA, Judson MA. New advances in the management of pulmonary sarcoidosis. BMJ 2019; 367: 15553.

2. Kolek V, Losťáková V, Vašáková M, Žurková M. Sarkoidóza (Doporučený postup diagnostiky, terapie a sledování vývoje onemocnění). Dostupné na: www.pneumologie.cz/guidelines, navštíveno: 8. 8. 2020.

3. Crouser ED, Maier LA, Wilson KC, et al. Diagnosis and detection of sarcoidosis. AJRCCM 2020; 8: e26–e51.

4. Jeny F, Bernaudin JF, Cohen Aubart F, et al. Diagnosis issues in sarcoidosis. Respir Med and Res 2020; 77: 37–45.

5. Scadding JG. Prognosis of intrathoracic sarcoidosis in England. A review of 136 cases after five years‘ observation. Br Med J 1961; 2: 1165–1172.

6. Statement on sarcoidosis. Joint statement of American Thoracici Society (ATS), the European Respiratory Society (ERS) and the World Association of Sarcoidosis and Other Granulomatous Disorders (WASOG). AJRCCM 1999; 160: 736–755.

7. Kidd DP. Neurosarcoidosis: clinical manifestations, investigation and treatment. Pract Neurol 2020; 20: 199–2121.

8. Roth D, Kadoglou N, Leeflang M, et al. Diagnostic accuracy of cardiac MRI, FDG- PET, and myocardial biopsy for the diagnosis of cardiac sarcoidosis: a protocol for a systematic review and meta -analysis. Diagnostic and Prognostic Research 2020; 4: 5.

9. Baughman RP, Scholand MB, Rahaghi FF. Clinical phenotyping: role in treatemnt decisions in sarcoidosis. Eur Respir Rev 2020; 29: 190145.

10. Jammal TE, Jamilloux Y, Gerfraud- Valentin M, et al. Refractory sarcoidosis: A Review. Therapeutics and Clinical Risk Management 2020; 16: 323–345.

11. Vis R, van de Garde EWM, Grutters J, Korenromp IHE. The effects of pharmacological interventions on quality of life and fatigue in sarcoidosis: a systematic review. Eur Respir Rev 2020; 29: 190057.

12. Baughman RP, Nagai S, Balter M, et al. Defining the clinical outcome status (COS) in sarcoidosis: results of WASOG Task Force. Sarcoidosis Vasc Diffuse Lung Dis 2011; 28: 56–64.

13. Kirkil G, Lower EE, Baughman RP. Predictors of mortality in pulmonary sarcoidosis. Chest 2018; 153: 105–113.

14. Gottlieb JE, Israel HL, Steiner RM, et al. Outcome in sarcoidosis. The realtionship of relapse to corticosteroid therapy. Chest 1997; 111: 623–631.

15. McKinzie BP, Bullington WM, Mazur JE, Judson MA. Efficiancy of short- course, low-dose corticosteroid therapy for acute pulmonary sarcoidosis exacerbations. Am J Med Sci 2010; 339: 1–4.

16. Martin K, Bentaberry F, Dumoulin C, et al. Peripherall neuropathy associated with leflunomide: is there a risk patient profile? Pharmacoepidemiol Drug Saf 2007; 16: 74–78.

17. Drent M, Cremers JP, Jansen TL, Baughman RP. Practical eminence and experienca-based recommendations for use of TNF -alpha inhibitors i sarcoidosis. Carcoidosis Vasc Diffuse Lung Dis 2014; 31: 91–107.