Description of a clinical population of sarcoidosis and examination of the association between cigarette smoking and sarcoidosis severity (original) (raw)
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Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature, 2021
Background: Sarcoidosis most commonly affects lungs and intrathoracic lymph nodes, but any other organ can be involved. In epidemiological studies, many occupational and environmental exposures have been linked to sarcoidosis but their relationship with the disease phenotype has barely been studied. Objective: To investigate how occupational and environmental exposures prior to diagnosis relate to organ involvement in patients with sarcoidosis Methods: We retrospectively studied patients seen at a sarcoidosis clinic between 2017 and 2020. Patients were included if they had a clinical presentation consistent with sarcoidosis and histologically confirmed epithelioid granulomas or had Löfgren syndrome. In a case-case analysis using multivariable logistic regression we calculated odds ratios (OR) of prespecified exposure categories (based on expert ascertainment) for cases with a given organ involvement versus cases without this organ involvement. Results: We included 238 sarcoidosis patients. Sarcoidosis limited to pulmonary involvement was associated with exposure to inorganic dust prior to diagnosis (OR 2.11; 95% confidence interval [CI] 1.11-4.17). Patients with liver involvement had higher odds of contact with livestock (OR 3.68; 95% CI 0.91-12.7) or having jobs with close human contact (OR 4.33; 95% CI 1.57-11.3) than patients without liver involvement. Similar associations were found for splenic involvement (livestock: OR 4.94, 95% CI 1.46-16.1; close human contact: OR 3.78; 95% CI 1.47-9.46). Cardiac sarcoidosis was associated with exposure to reactive chemicals (OR 5.08; 95% CI 1.28-19.2) or livestock (OR 9.86; 95% CI 1.95-49.0). Active smokers had more ocular sarcoidosis (OR 3.26; 95% CI 1.33-7.79). Conclusions: Our study indicates that, in sarcoidosis patients, different exposures might be related to different organ involvements-hereby providing support for the hypothesis that sarcoidosis has more than one cause, each of which may promote a different disease phenotype.
Sarcoidosis: Causes, Diagnosis, Clinical Features, and Treatments
Journal of Clinical Medicine
Sarcoidosis is a multisystem granulomatous disease with nonspecific clinical manifestations that commonly affects the pulmonary system and other organs including the eyes, skin, liver, spleen, and lymph nodes. Sarcoidosis usually presents with persistent dry cough, eye and skin manifestations, weight loss, fatigue, night sweats, and erythema nodosum. Sarcoidosis is not influenced by sex or age, although it is more common in adults (< 50 years) of African-American or Scandinavians decent. Diagnosis can be difficult because of nonspecific symptoms and can only be verified following histopathological examination. Various factors, including infection, genetic predisposition, and environmental factors, are involved in the pathology of sarcoidosis. Exposures to insecticides, herbicides, bioaerosols, and agricultural employment are also associated with an increased risk for sarcoidosis. Due to its unknown etiology, early diagnosis and detection are difficult; however, the advent of adva...
Genetic, Immunologic, and Environmental Basis of Sarcoidosis
Annals of the American Thoracic Society, 2017
Sarcoidosis is a multisystem disease with tremendous heterogeneity in disease manifestations, severity, and clinical course that varies among different ethnic and racial groups. To better understand this disease and to improve the outcomes of patients, a National Heart, Lung, and Blood Institute workshop was convened to assess the current state of knowledge, gaps, and research needs across the clinical, genetic, environmental, and immunologic arenas. We also explored to what extent the interplay of the genetic, environmental, and immunologic factors could explain the different phenotypes and outcomes of patients with sarcoidosis, including the chronic phenotypes that have the greatest healthcare burden. The potential use of current genetic, epigenetic, and immunologic tools along with study approaches that integrate environmental exposures and precise clinical phenotyping were also explored. Finally, we made expert panel-based consensus recommendations for research approaches and pr...
Sarcoidosis as a systemic disease
Clinics in Dermatology, 2014
Sarcoidosis is a systemic disease, where the abnormal localized collections of chronic inflammatory cells, the granuloma is cardinal, which may result in the formation of nodule(s) in the tissue of any organ of the body, lungs and lymph nodes involvement being the most common. The granulomas are non-necrotizing. The disease may either be asymptomatic or chronic. Its onset is gradual and may improve/clear up spontaneously.
Analysis of 275 patients with sarcoidosis over a 38 year period; a single-institution experience
Respiratory Medicine, 2007
Background: Sarcoidosis is a systemic granulomatous disease with unknown etiology. Objectives: We evaluated seasonal variation, demographic, clinical and diagnostic features of sarcoidosis in recently diagnosed symptomatic patients in the whole cohort (275 patients) and in the subgroups according to the estimated disease course (subacute course group vs. chronic course group). We also developed a prediction model to predict the course of sarcoidosis using simple clinical and demographic variables. Material and methods: Two hundred and seventy-five patients with sarcoidosis. Measurements and statistics: Roger's test, chi-square, t-test and multiple logistic regression were used. Results: The distribution of cumulative monthly diagnosis was the lowest in November (fall) (po0.01). Seasonal pattern was influenced by age and gender. Constitutional symptoms, stages 2 and 3 diseases and the absence of erythema nodosum were highly significant parameters for chronic course. Using these variables, the developed model had a specificity of 93.1% and its positive predictive value was 89.5%. Progression of the disease was documented 6.4% in subacute group vs. 32.1% in chronic group (p ¼ 0:00001). Preventive effect of smoking was more pronounced in females than in males in our cohort. Conclusions: Further well-designed and large prospective studies are required to better understand the importance of these findings, and to validate the prediction model presented here.
A case control etiologic study of sarcoidosis: environmental and occupational risk …
American journal of …, 2004
A Case Control Etiologic Study of Sarcoidosis: Environmental and Occupational Risk ... 1Lee S. Newman, MD, MA 1Cecile S. Rose, MD, MPH 2Eddy A. Bresnitz, MD, MS 3Milton D. Rossman, MD 1Juliana Barnard, MA 4Margaret Frederick, Ph.D. 4Michael L. Terrin, MD, ...
Sarcoidosis: A Clinical Overview from Symptoms to Diagnosis
Cells
Sarcoidosis is a multi-system disease of unknown etiology characterized by the formation of granulomas in various organs. It affects people of all ethnic backgrounds and occurs at any time of life but is more frequent in African Americans and Scandinavians and in adults between 30 and 50 years of age. Sarcoidosis can affect any organ with a frequency varying according to ethnicity, sex and age. Intrathoracic involvement occurs in 90% of patients with symmetrical bilateral hilar adenopathy and/or diffuse lung micronodules, mainly along the lymphatic structures which are the most affected system. Among extrapulmonary manifestations, skin lesions, uveitis, liver or splenic involvement, peripheral and abdominal lymphadenopathy and peripheral arthritis are the most frequent with a prevalence of 25–50%. Finally, cardiac and neurological manifestations which can be the initial manifestation of sarcoidosis, as can be bilateral parotitis, nasosinusal or laryngeal signs, hypercalcemia and ren...