Health-related quality of life (QOL) has become an important topic in health care. However, hardly any attention has been paid to QOL in sarcoidosis. Therefore, the aim of this study was to assess the impact of sarcoidosis on QOL. Sixty-four sarcoidosis patients completed the World Health Organization Quality of Life assessment instrument (WHOQOL-100) and the Beck Depression Inventory (BDI). For the WHOQOL-100 a matched group of healthy controls was selected. Patients were divided into two groups: group I (n = 37) consisted of patients with actual symptoms, group II (n = 27) consisted of asymptomatic patients. The WHOQOL-100 revealed a number of areas in which sarcoidosis patients, especially those with current symptoms, experienced problems. A major symptom in both groups of sarcoidosis patients was fatigue. No association between the facet fatigue and the domain psychological health was found. Depressive symptoms (BDI) were associated with psychological function (WHOQOL-100). No association between pulmonary function tests and QOL was found. In conclusion, this study shows that sarcoidosis has a considerable impact on the QOL of patients. The WHOQOL-100 appeared to be a sensitive instrument to measure fatigue--one of the most common symptoms in sarcoidosis--which otherwise is difficult to assess objectively.

The pathophysiological explanation for fatigue, one of the most common symptoms in sarcoidosis, still has to be elucidated. It was hypothesized that the presence of fatigue is associated with an acute phase response in sarcoidosis.A cross-sectional study was performed in 38 sarcoidosis patients. Resting energy expenditure (REE) was measured in the fasting state by indirect calorimetry using a ventilated hood and adjusted for fat-free mass (FFM).Patients with fatigue (n=25) also suffered more frequently from other symptoms, such as exercise intolerance (p=0.01), the need for sleep (p=0.02) and weight loss (p= 0.01), compared to those without fatigue (n=13). However, no relationship was found between fatigue and serum angiotensin-converting enzyme (sACE) or lung function impairment. Patients with fatigue had higher levels of C-reactive protein (CRP) (11.4 6.8 mg . mL -1 , p<0.0001) and REE adjusted for FFM (33.0 3.7 kcal . kg FFM -1 , p<0.003) compared to those without fatigue (3.2 2.2 mg . mL -1 ; 29.2 2.8 kcal . kg FFM -1 ). Furthermore, REE/FFM was significantly related to CRP (r=0.54, p=0.001).This study confirms the presence of an acute phase response as indicated by metabolic derangements and a moderate increase in C-reactive protein levels in sarcoidosis, particularly in those patients with constitutional symptoms. Future studies should focus on the clinical relevance and therapeutic implications of these findings. Eur Respir J 1999; 13: 718±722.

Sarcoidosis patients suffered from a broad range of persistent physical symptoms. In this study fatigue appeared to be the most commonly reported symptom. Intervention programs should focus on physical health as well as psychosocial aspects such as teaching patients how to cope with the disease.

In sarcoidosis, pulmonary and general symptoms often do not correlate with radiographic stage and routinely performed lung function tests. Asymptomatic muscle involvement in sarcoidosis is common, but little is known about respiratory muscle involvement. The aim of this study was to investigate any relationships between persistent complaints and/or quality of life and respiratory muscle strength and endurance, respectively.Measurements of maximal inspiratory and expiratory mouth pressures (PI,max and PE,max), respiratory muscle endurance and routine lung function were made in 18 patients with sarcoidosis. To assess health status and quality of life, patients completed the Sickness Impact Profile (SIP).Respiratory muscle strength and endurance time were lower in the patient group than in a group of healthy controls (p=0.05). Compared to a general population, the patients with sarcoidosis were found to be limited in physical and psychosocial functioning. The respiratory muscle endurance time correlated with the SIP subscales "mobility" (r=-0.56; p<0.01), and "body care and movement" (r=-0.79; p<0.001). The total lung capacity (TLC), inspiratory vital capacity (IVC) and forced expiratory volume in one second (FEV1) were normal in all subjects.In conclusion, patients with sarcoidosis and normal lung function showed reduced respiratory muscle strength and endurance time. Correlations were found between these indices and both symptoms and certain Sickness Impact Profile domains. Therefore, we suggest inclusion of measurements of respiratory muscle strength in the assessment and follow-up of patients with sarcoidosis.

Impairment of quality of lifeWirnsberger, R.M.; de Vries, J.; Jansen, T.L.Th.A.; van Heck, G.L.; Wouters, E.F.M.; Drent, M. Published in:The Netherlands Journal of Medicine Document version:Publisher's PDF, also known as Version of record General rightsCopyright and moral rights for the publications made accessible in the public portal are retained by the authors and/or other copyright owners and it is a condition of accessing publications that users recognise and abide by the legal requirements associated with these rights.-Users may download and print one copy of any publication from the public portal for the purpose of private study or research -You may not further distribute the material or use it for any profit-making activity or commercial gain -You may freely distribute the URL identifying the publication in the public portal Take down policy If you believe that this document breaches copyright, please contact us providing details, and we will remove access to the work immediately and investigate your claim. Abstract Background: Quality of life (QOL) has become an important item in health care. QOL should be a major target of treatment in chronic diseases such as rheumatoid arthritis (RA) and sarcoidosis. The aim of this study was to compare the impact of RA and sarcoidosis on patients' QOL. We expected more serious impairment of QOL in the RA group than in the sarcoidosis group.Methods: QOL was studied in RA patients (n 5 32), sarcoidosis patients (n 5 37), and a healthy control group (n 5 37) employing the World Health Organization Quality of Life assessment instrument (WHOQOL-100).Results: In both patient groups QOL was impaired with respect to Physical Health, Level of Independence (P , 0.001), and Overall QOL and General Health (P , 0.01). Moreover, RA patients appeared to have a lower QOL with respect to Pain and Discomfort (P , 0.001) and Mobility (P , 0.001).Conclusions: In RA and sarcoidosis, fatigue and sleep were major problems. In contrast to our expectations, with respect to activities of daily living and working capacity, the two patient groups did not show any difference. Impairment of QOL was more serious and included more aspects of QOL in RA than in sarcoidosis. (See Editorial p. 83.)