Relapses of sarcoidosis: what are they and can we predict who will get them?

Baughman, Robert P.; Judson, Marc A.

doi:10.1183/09031936.00138913

Cited by 45 publications

(32 citation statements)

References 35 publications

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“…There is an increased risk for extreme daytime sleepiness even with less severe dyspnea. Dyspnea is an indicator of the severity of sarcoidosis [29] , and a high MRC grade is interpreted as an expression of a stronger impairment of the patient. Then again, fatigue and dyspnea were reduced by a physical training program for 13 weeks [30] .…”

Section: Discussionmentioning

confidence: 99%

Fatigue and Excessive Daytime Sleepiness in Sarcoidosis: Prevalence, Predictors, and Relationships between the Two Symptoms

et al. 2017

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Background: Fatigue is common among patients with sarcoidosis. The etiology of this problem is unknown and multifactorial. Fatigue can be confounded with excessive daytime sleepiness (EDS). Fatigue and sleepiness have rarely been studied simultaneously in sarcoidosis patients. Objectives: The aim of this study was the confounder-adjusted estimation of risks for severe fatigue and EDS in a large population of sarcoidosis patients and the development of multivariate predictors from this population. Methods: 1,197 German sarcoidosis patients were examined using the Epworth Sleepiness Scale (ESS), the Fatigue Assessment Scale (FAS), the Hospital Anxiety and Depression Scale (HADS), and the Medical Research Council (MRC) dyspnea scale. Results: 16.5% (123 patients) had EDS (ESS ≥16), 16.4% had severe fatigue (FAS ≥35), and 6.3% had both extreme findings. In a multivariate logistic regression model, predictors of the risk of EDS were a history of sleep apnea (odds ratio [OR] 2.46, 95% confidence interval [CI] 1.5-3.9), dyspnea MRC grade ≥2 (OR 2.29, 95% CI 1.5-3.5), and organ involvement of 4-7 organs (OR 1.60, 95% CI 1.1-2.4). Significantly associated with higher risk of severe fatigue were the following: conspicuous depression (OR 5.95, 95% CI 4.1-8.7), conspicuous anxiety (OR 2.38, 95% CI 1.6-3.4), and muscle pain (OR 1.92, 95% CI 1.32-2.75). The logit models for severe fatigue with and without simultaneous EDS differed only slightly. Conclusion: An extreme form of fatigue and/or sleepiness was found in 27% of all sarcoidosis patients questioned. Because there is a certain overlap, both should be examined simultaneously to allow for a combined assessment.

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Section: Discussionmentioning

confidence: 99%

Fatigue and Excessive Daytime Sleepiness in Sarcoidosis: Prevalence, Predictors, and Relationships between the Two Symptoms

et al. 2017

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“…However, it has been shown, particularly in stage 4, that in the presence of pulmonary worsening, it is necessary to discuss the underlying mechanism, either an associated condition such as an additional infection versus a true exacerbation of sarcoidosis [32,33]. In the case presented, two elements called for an investigation: first, the occurrence of the event in a patient with a controlled disease with a long-term stable treatment [5,34]; second, the notion of underlying stage 4 disease with long-duration corticosteroid/immunosuppressive treatment. A diagnosis of an additional infection by M. kansasii was confirmed and on appropriate antimycobacterial treatment without any modification of the sarcoidosis treatment, symptoms were alleviated and pulmonary function : blood cell counts, blood creatinine, blood calcium, 24-h urinary calcium, aspartate aminotransferase, alanine aminotransferase, alkaline phosphatase, γ-glutamyltransferase, serum protein electrophoresis and angiotensin-converting enzyme; ¶ : indications for HRCT were 1) atypical clinical and/or radiographic findings, 2) normal chest radiography but a clinical suspicion of sarcoidosis, and 3) detection of pulmonary complications.…”

Section: Discussionmentioning

confidence: 99%

Management of sarcoidosis in clinical practice

et al. 2016

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Sarcoidosis is a systemic disease of unknown cause with very diverse presentation, outcome, severity and need for treatments. While some presentations may be very typical, for many patients, the presentation is nonspecific, with shared associations with other diseases at times being by far more frequent or misleading, which can be a cause of significant delay and often several consultations before a diagnosis of sarcoidosis can be confirmed. This is particularly the case when pulmonary manifestations are in the forefront. The diagnosis relies on three well-known criteria. In clinical practice, these criteria are not easily implemented, particularly by physicians without expertise in sarcoidosis, which can lead to a risk of either under-or over-diagnosis. Qualifying the presentation according to sarcoidosis diagnosis is essential. However, it is often not easy to classify the presentation as typical versus compatible or compatible versus inconsistent. Further investigations are needed before any other hypothesis is to be considered. It is important to detect events and to determine whether or not they are indicative of a flare of sarcoidosis. Eventually, treatment needs to be related to the correct indications. The evaluation of the efficacy and safety of treatments is crucial. To address such issues, we present five emblematic cases that illustrate this. @ERSpublications Showing emblematic cases is the best way to illustrate the multiple conditions to deal with for managing sarcoidosis http://ow.ly/10A5Yv

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“…Repeated courses of treatment with corticosteroids and use of other drugs are common, due to frequent relapses. This phenotype is best characterized as persistent instead of relapsing [18], since in most of the cases the disease may have never really been under control, but simply the manifestation became more apparent as antiinflammatory drugs are withdrawn [13,66]. Persistent fibrosing sarcoidosis is characterized by chest radiographic stage IV, abnormal spirometry (restrictive, obstructive or both), longer duration of symptoms and more frequent skin lesions (excluding erythema nodosum) [18,23].…”

Section: Clinical Phenotypesmentioning

confidence: 99%