Sarcoidosis: Internal medicine perspective

Саркоидоз: взгляд терапевта
Mehtap Tınazlı 1, Gaukhar Bakhtiyarova 1
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1 Near East University Hospital, Internal Medicine Department, Northern Cyprus, Nicosia
J CLIN MED KAZ, Volume 3, Issue 41, pp. 6-13. https://doi.org/10.23950/1812-2892-2016-3-6-13
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ABSTRACT

Sarcoidosis is a systemic autoimmune disease characterized by noncaseatinggranulomatous inflammation with unknown etiology.Although the lungs and respiratory system are most commonlyinvolved, sarcoidosis may involve virtually any part of the body,including the locomotor system, eyes, skin, lymph nodes. Diagnosis attained via consensus between the clinical presentation and natural history, pattern of major organ involvement, confirmatory biopsy, and response to therapy. Histopathological features remain the gold standard in diagnosis. Radiologic staging in sarcoidosis is based on the chest X-ray. If chest radiographis normal, high-resolution computed tomography (HRCT) can demonstrate pathological changes in a detailed manner. Sarcoidosis generally follows a benign course with occasional spontan remissions. The most important causes of mortality are acute and chronic respiratory failure, pulmonary hypertension and hemoptysis due to aspergillosis. When treatment is indicated, glucocorticoids remain the only recognized effective therapy for active sarcoidosis. Level of evidence for management of sarcoidosis is low, generally reflecting the results of limited number of clinical studies, case series and expert opinion. In selected cases, biological agents including, tumour necrosis factor inhibitors, seem to be promising.
Keywords: sarcoidosis, diagnosis, treatment

CITATION

Tınazlı M, Bakhtiyarova G. Sarcoidosis: Internal medicine perspective. Journal of Clinical Medicine of Kazakhstan. 2016;3(41):6-13. https://doi.org/10.23950/1812-2892-2016-3-6-13

REFERENCES

  • Hunninghake GW, Costabel U, Ando M, et al. ATS/ERS/WASOG statement on sarcoidosis. American Thoracic Society/ European Respiratory Society/World Association of Sarcoidosis and other Granulomatous Disorders. Sarcoidosis Vas Diffuse Lung Dis 1999;16:149-173.
  • Ten Berge B, Kleinjan A, Muskens F, Hammad H, Hoogsteden HC, Hendriks RW, et al. Evidence for local dendritic cell activation in pulmonary sarcoidosis. Respir Res. 2012 18. 13:33.
  • Kitaichi M. Prevalence of sarcoidosis around the world. Sarcoidosis Vas Diffuse Lung Dis 1998;15:16-18.
  • Siltzbach LE, James DG, Neville E, et al. Course and prognosis of sarcoidosis around the world. Am J Med 1974;57:847-852.
  • Rybicki BA, Major M, Popovich J Jr,Maliarik MJ, Iannuzzi MC. Racial differences in sarcoidosis incidence: a 5-year study in a health maintenance organization. Am J Epidemiol 1997;145:234-241.
  • Pietinalho A, Hiraga Y, Hosoda Y, Lofroos AB, Yamaguchi M, Selroos O. The frequency of sarcoidosis in Finland and Hokkaido, Japan: a comparative epidemiological study. Sarcoidosis1995;12:61-6.
  • Baughman RP, Teirstein AS, Judson MA, et al. Clinical characteristics of patients in a case control study of sarcoidosis. Am J Respir Crit Care Med 2001;164:18851889.
  • Milman N, Selroos O. Pulmonary sarcoidosis in the Nordic countries 1950-1982: epidemiology and clinical picture.Sarcoidosis 1990;7:50-57.
  • Rabin DL, Thompson B, Brown KM, et al. Sarcoidosis: social predictors of severity at presentation. Eur Respir J2004;24:601- 608.
  • Martenstein H. Knochveranderungen bei lupus pernio.Z Haut Geschlechskr1923;7:308-308.
  • Familial associations in sarcoidosis: a report to the Research Committee of the British Thoracic and Tuberculosis Association. Tubercle1973;54:87-98.
  • Rybicki BA,Iannuzzi MC,Frederick MM, et al. Familial aggregation of sarcoidosis: A Case-Control Etiologic Study of Sarcoidosis (ACCESS). Am J Respir Crit Care Med 2001;164:2085-2091.
  • Judson MA,Hirst K,Iyengar SK, et al. Comparison of sarcoidosis phenotypes among affected African-American siblings. Chest2006;130:855-862.
  • Brewerton DA,Cockburn C,James DC,James DG,Neville E. HLA antigens in sarcoidosis.Clin Exp Immunol1977;27:227-229.
  • Rossman MD,Thompson B,Frederick M, et al. HLA-DRB1*1101: a significant risk factor for sarcoidosis in blacks and whites. Am J Hum Genet 2003;73:720-735.
  • Lannuzzi MC,Maliarik MJ,Poisson LM,Rybicki BA. Sarcoidosis susceptibility and resistance HLA-DQB1 alleles in African Americans. Am J Respir Crit Care Med 2003;167:1225-1231.
  • Voorter CE,Amicosante M,Berretta F,Groeneveld L,Drent M,van den Berg-Loonen EM. HLA class II amino acid epitopes as susceptibility markers of sarcoidosis.Tissue Antigens 2007;70:18-27.
  • Sato H, Grutters JC, Pantelidis P, et al. HLA-DQB1*0201: a marker for good prognosis in British and Dutch patients with sarcoidosis. Am J Respir Cell Mol Biol 2002;27:406-412.
  • Lannuzzi MC, Rybicki BA. Genetics of sarcoidosis: candidate genes and genome scans.Proc Am Thorac Soc2007;4:108-116
  • Valentonyte R, Hampe J, Croucher PJ, et al. Study of C-C chemokine receptor 2 alleles in sarcoidosis, with emphasis on familybased analysis. Am J Respir Crit Care Med 2005;171:1136-1141.
  • Rybicki BA,Maliarik MJ,Poisson LM,Iannuzzi MC. Sarcoidosis and granuloma genes: a family-based study in AfricanAmericans.Eur Respir J2004;24:251-257.
  • Schurmann M, Reichel P, Muller-Myhsok B, Schlaak M, Muller-Quernheim J,Schwinger E. Results from a genome-wide search for predisposing genes in sarcoidosis. Am J Respir Crit Care Med 2001;164:840-846.
  • Lannuzzi MC,Iyengar SK,Gray-McGuire C, et al. Genome-wide search for sarcoidosis susceptibility genes in African Americans.Genes Immun2005;6:509-518.
  • Bresnitz EA,Strom BL. Epidemiology of sarcoidosis.Epidemiol Rev 1983;5:124-156.
  • Rybicki BA,Amend KL,Maliarik MJ,Iannuzzi MC. Photocopier exposure and risk of sarcoidosis in African-American sibs. Sarcoidosis Vasc Diffuse Lung Dis2004;21:49-55.
  • Newman LS,Rose CS,Bresnitz EA, et al. A case control etiologic study of sarcoidosis: environmental and occupational risk factors.Am J Respir Crit Care Med 2004;170:1324-1330.
  • Kucera GP,Rybicki BA,Kirkey KL, et al. Occupational risk factors for sarcoidosis in African-American siblings. Chest2003;123:1527-1535.
  • Gorham ED,Garland CF,Garland FC,Kaiser K,Travis WD,Centeno JA. Trends and occupational associations in incidence of hospitalized pulmonary sarcoidosis and other lung diseases in Navy personnel: a 27-year historical prospective study, 1975- 2001.Chest2004;126:1431-1438.
  • Prezant DJ,Dhala A,Goldstein A, et al. The incidence, prevalence, and severity of sarcoidosis in New York City firefighters. Chest1999;116:1183-1193.
  • Barnard J,Rose C,Newman L, et al. Job and industry classifications associated with sarcoidosis in A Case-Control Etiologic Study of Sarcoidosis (ACCESS).J Occup Environ Med 2005;47:226-234. 
  • Izbicki G,Chavko R,Banauch GI, et al. World Trade Center “sarcoid-like” granulomatous pulmonary disease in New York City Fire Department rescue workers.Chest2007;131:1414-1423.
  • Moller DR. Rare manifestations of sarcoidosis. In : Drent M, Costabel U, eds. Sarcoidosis. Vol 10. Wakefield, UK: Europan Respiratory Society Journals, Ltd.; 2005:233-250.
  • Grunewald J, Eklund A. Sex-specific manifestations of Lofgren’s syndrome. Am J Respir Crit Care Med2007;175:40-44
  • Idali F, Wilken M, Wahlstrom J et al. Reduced Th1 response in the lungs of HLA-DRB1*0301 patient with pulmonary sarcoidosis. Eur Respir 2006;27:451-459.
  • Michael C. Iannuzzi M.D. Benjamin A, Rybicki Ph.D. and Alvin S, Teirstein, M.D. Sarcoidosis. N Engl J Med 2007; 357: 2153-2165.
  • Scadding JG. Prognosis of intrathoracic sarcoidosis in England: a rewiew of 136 cases after five years observation. BMJ 1961;2:1165-1171.
  • Judson MA, Baughman RP, Thompson BW, et al/ two year prognosis of sarcoidosis: the ACCESS experience. Sarcoidosis Vasc Diffuse Lung Dis 2003;20: 204-211.
  • Shorr AF,Torrington KG,Hnatiuk OW. Endobronchial involvement and airway hyperreactivity in patients with sarcoidosis. Chest 2001;120:881-886.
  • Fisher KA,Serlin DM,Wilson KC,Walter RE,Berman JS,Farber HW. Sarcoidosis-associated pulmonary hypertension: outcome with long-term epoprostenol treatment.Chest2006;130:1481-1488
  • Handa T, Nagai S, Miki S, et al. Incidence of pulmonary hypertension and its clinical relevance in patients with sarcoidosis. Chest2006;129:1246-1252.
  • Yanardag H,Pamuk ON,Pamuk GE. Lupus pernio in sarcoidosis: clinical features and treatment outcomes of 14 patients. J Clin Rheumatol 2003;9:72-76.
  • Baughman RP,Teirstein AS,Judson MA, et al. Clinical characteristics of patients in a case control study of sarcoidosis.Am J Respir Crit Care Med 2001;164:1885-1889.
  • Scott GC,Berman JM,Higgins JL Jr. CT patterns of nodular hepatic and splenic sarcoidosis: a review of the literature. J Comput Assist Tomogr 1997;21:369-372.
  • Judson MA. Hepatic, splenic, and gastrointestinal involvement with sarcoidosis.Semin Respir Crit Care Med2002;23:529-541.
  • Harder H,Buchler MW,Frohlich B, et al. Extrapulmonary sarcoidosis of liver and pancreas: a case report and review of literature. World J Gastroenterol 2007;13:2504-2509.
  • Scott TF,Yandora K,Valeri A,Chieffe C,Schramke C. Aggressive therapy for neurosarcoidosis: long-term follow-up of 48 treated patients. Arch Neurol 2007;64:691-696.
  • Spencer TS,Campellone JV,Maldonado I,Huang N,Usmani Q,Reginato AJ. Clinical and magnetic resonance imaging manifestations of neurosarcoidosis.Semin Arthritis Rheum2005;34:649-661.
  • Kellinghaus C,Schilling M,Ludemann P. Neurosarcoidosis: clinical experience and diagnostic pitfalls.Eur Neurol2004;51:84-88.
  • Bonfioli AA,Orefice F. Sarcoidosis.Semin Ophthalmol 2005;20:177-182.
  • Uemura A,Morimoto S,Hiramitsu S,Kato Y,Ito T,Hishida H. Histologic diagnostic rate of cardiac sarcoidosis: evaluation of endomyocardial biopsies. Am Heart J1999;138:299-302.
  • Grimm W,Alter P,Maisch B. Arrhythmia risk stratification with regard to prophylactic implantable defibrillator therapy in patients with dilated cardiomyopathy: results of MACAS, DEFINITE, and SCD-HeFT.Herz 2004;29:348-352.
  • Berliner AR,Haas M,Choi MJ. Sarcoidosis: the nephrologist’s perspective.Am J Kidney Dis 2006;48:856-870.
  • Kaplan H. Sarcoid arthritis. A review. Arch Intern Med 1963;112:924-935.
  • Wilcox A, Bharadwaj P, Sharma OP. Bone sarcoidosis. Curr Opin Rheumatol 2000;12:321-330.
  • Kennedy PT, Zakaria N, Modawi SB, et al. Natural history of hepatic sarcoidosis and its response to treatment. Eur J Gastroenterol Hepatol 2006;18:721-726.
  • Lower EE, Smith JT, Martelo OJ, Baughman RP. The anemia of sarcoidosis. Sarcoidosis 1988;5:51-55.
  • Fasano MB, Sullivan KE, Sarpong SB, et al. Sarcoidosis and common variable immunodeficiency. Report of 8 cases and review of the literature. Medicine (Baltimore) 1996;75:251-261.
  • Annema JT,Veselic M,Rabe KF. Endoscopic ultrasound-guided fine-needle aspiration for the diagnosis of sarcoidosis.Eur Respir J 2005;25:405-409.
  • Judson MA,Baughman RP,Teirstein AS,Terrin ML,Yeager H Jr. Defining organ involvement in sarcoidosis: the ACCESS proposed instrument. Sarcoidosis Vasc Diffuse Lung Dis 1999;16:75-86.
  • Statement on sarcoidosis: joint statement of the American Thoracic Society (ATS), the European Respiratory Society (ERS) and the World Association of Sarcoidosis and Other Granulomatous Disorders (WASOG) adopted by the ATS Board of Directors and by the ERS Executive Committee, February 1999. Am J Respir Crit Care Med 1999;160:736-755.
  • Nunes H,Brillet PY,Valeyre D,Brauner MW,Wells AU. Imaging in sarcoidosis.Semin Respir Crit Care Med2007;28:102-120.
  • Kruit A,Grutters JC,Gerritsen WB, et al. ACE I/D-corrected Z-scores to identify normal and elevated ACE activity in sarcoidosis. Respir Med 2007;101:510-515.
  • Studdy PR,Bird R. Serum angiotensin converting enzyme in sarcoidosis its value in present clinical practice.Ann Clin Biochem 1989;26:13-18.
  • Johns CJ,Michele TM. Theclinical management of sarcoidosis. A 50-year experience at the Johns Hopkins Hospital. Medicine 1999;78:65-111.
  • Paramothayan S,Lasserson TJ,Walters EH. Immunosuppressive and cytotoxic therapy for pulmonary sarcoidosis.Cochrane Database Syst Rev2006;3:CD003536-CD003536. 
  • Baughman RP, Winget DB, Lower EE. Methotrexate is steroid sparing in acute sarcoidosis: results of a double blind, randomized trial. Sarcoidosis Vasc Diffuse Lung Dis 2000; 17: 60-66.
  • Adams JS, Diz MM, Sharma OP. Effective reduction in the serum 1.25-dihydroxyvitamin D and calcium concentration in sarcoidosis-associated hypercalcemia with short-course chloroquine therapy. Ann Intern Med 1989; 111:437-438.
  • Sharma OP. Effectiveness of chloroquine and hydroxychloroquine in treating selected patients with sarcoidosis with neurological involvement. Arch Neurol 1998;55:1248-1254.
  • Bachelez H,Senet P,Cadranel J,Kaoukhov A,Dubertret L. The use of tetracyclines for the treatment of sarcoidosis. Arch Dermatol 2001;137:69-73.
  • Sapadin AN,Fleischmajer R. Tetracyclines: nonantibiotic properties and their clinical implications. J Am Acad Dermatol 2006;54:258-265.
  • Baughman RP,Iannuzzi M. Tumour necrosis factor in sarcoidosis and its potential for targeted therapy.Biodrugs2003;17:425-431.
  • Denys BG,Bogaerts Y,Coenegrachts KL,De Vriese AS. Steroid-resistant sarcoidosis: is antagonism of TNF-alpha the answer? Clin Sci (Lond)2007;112:281-289.
  • Baughman RP,Drent M,Kavuru M, et al. Infliximab therapy in patients with chronic sarcoidosis and pulmonary involvement. Am J Respir Crit Care Med 2006;174:795-802.
  • Hernandez-Pando R,Bornstein QL,Aguilar Leon D,Orozco EH,Madrigal VK,Martinez Cordero E. Inflammatory cytokine production by immunological and foreign body multinucleated giant cells.Immunology2000;100:352-358.
  • Agostini C,Adami F,Semenzato G. New pathogenetic insights into the sarcoid granuloma.Curr Opin Rheumatol2000;12:71-76.
  • Silver RF, Crystal RG, Moller DR. Limited heterogeneity of biased T-cell receptor V beta gene usage in lung but not blood T cells in active pulmonary sarcoidosis.Immunology1996;88:516-523.
  • Zissel G, Prasse A, Muller-Quernheim J. Sarcoidosis immunopathogenetic concepts.Semin Respir Crit Care Med 2007;28:3-14.
  • Ho LP,Urban BC,Thickett DR,Davies RJ,McMichael AJ. Deficiency of a subset of T-cells with immunoregulatory properties in sarcoidosis.Lancet 2005;365:1062-1072.
  • Mempel M,Flageul B,Suarez F, et al. Comparison of the T cell patterns in leprous and cutaneous sarcoid granulomas: presence of Valpha24-invariant natural killer T cells in T-cell-reactive leprosy together with a highly biased T cell receptor Valpha repertoire. Am J Pathol 2000;157:509-523.
  • Miyara M, Amoura Z, Parizot C, et al. The immune paradox of sarcoidosis and regulatory T cells.J Exp Med2006;203:359-370 Erratum, J Exp Med 2006;203:477.
  • Doyle MK,Berggren R,Magnus JH. Interferon-induced sarcoidosis.J Clin Rheumatol2006;12:241-248.
  • Ramos-Casals M,Mana J,Nardi N, et al. Sarcoidosis in patients with chronic hepatitis C virus infection: analysis of 68 cases. Medicine (Baltimore)2005;84:69-80.
  • Kikawada M, Ichinose Y,Kunisawa A, et al. Sarcoidosis induced by interferon therapy for chronic myelogenous leukaemia. Respirology 1998;3:41-44.
  • Henry MT,McMahon K,Mackarel AJ, et al. Matrix metalloproteinases and tissue inhibitor of metalloproteinase-1 in sarcoidosis and IPF.Eur Respir J2002;20:1220-1227.
  • Fireman E,Kraiem Z,Sade O,Greif J,Fireman Z. Induced sputum-retrieved matrix metalloproteinase 9 and tissue metalloproteinase inhibitor 1 in granulomatous diseases.Clin Exp Immunol 2002;130:331-337.
  • Wahlstrom J,Katchar K,Wigzell H,Olerup O,Eklund A,Grunewald J. Analysis of intracellular cytokines in CD4+ and CD8+ lung and blood T cells in sarcoidosis. Am J Respir Crit Care Med 2001;163:115-121.
  • Prasse A, Pechkovsky DV, Toews GB, et al. A vicious circle of alveolar macrophages and fibroblasts perpetuates pulmonary fibrosis via CCL18. Am J Respir Crit Care Med 2006;173:781-792.