Sarcoidosis at the Pulmonary Medicine Department of a tertiary care hospital in Mumbai. Our experience and The New Modified Criteria Clinical Radiological Physiological (TNMC CRP) score for sarcoidosis: A novel proposition to assess the functional status

Abstract

Sarcoidosis is a multisystemic granulomatous disease most commonly involving the pulmonary system and having a myriad of manifestations. However literature is scanty pertaining to the profile and scoring system in sarcoidosis. This study was undertaken to understand the profile of sarcoidosis and an endeavor to assess the functional status with a simplified scoring system. This was an observational study undertaken in the department of Pulmonary Medicine at a tertiary care. The profile of these patients was studied in terms of clinical features, radiological findings, the New Modified Criteria Clinical Radiological Physiological (TNMC CRP) score, six-minute walk distance (6MWD), spirometry, arterial blood gas parameters, serum angiotensin converting enzyme (ACE) levels and tissue biopsy histopathology. The 68 patients included 41 women and 27 men with a mean age of 42.7 years. They comprised of 18 (27%), 39 (57%), 4 (6%), 7 (10%) cases of stage 1, 2, 3, 4 sarcoidosis respectively. Most common presenting symptom and sign was progressive dyspnea 49 (72%), and peripheral lymphadenopathy 15 (22%). Serum ACE was elevated in 57 (83%). The average 6MWD was 360 meters. Most common high resolution computed tomography (HRCT) finding was mediastinal lymphadenopathy and peri-bronchovascular nodules. Spirometry was restrictive abnormality in 48 (96%) patients. Evidence of pulmonary hypertension (PH) was present in 32 (47%) patients. Tissue diagnosis revealed granulomatous inflammation in 51 biopsies with a transbronchial lung biopsy (TBLB) yield of 62%. The average TNMC CRP score was 5. There was a positive correlation between this score and 6MWD which was statistically significant. The score correlated with the functional status. Diagnosis of sarcoidosis warrants a comprehensive and multimodality approach. HRCT and tissue biopsy are the most important diagnostic armamentariums. Modified simplified scores help assess the functional status of the disease.

High Resolution Computed Tomography (HRCT) for Evaluation of Pulmonary Manifestations in Patients with Autoimmune Diseases

“…In this study x ray of sarcoidosis shows bilateral hilar lymphadenopathy (100%) which is similar to that of the study of Ketaki Utpat, Chinnu Sasikumar, Unnati Desai, et al in which 95% of cases shows bilateral hilar lymphadenopathy [22].…”

Prevalence of Sarcoidosis-Associated Pulmonary Hypertension: A Systematic Review and Meta-Analysis

“…Three studies were removed for duplicated data used in another study ( 13 , 20 , 21 ). Finally, the analysis included 25 studies ( 7 , 11 , 12 , 22 – 43 ). The studies were conducted in the United States ( n = 10), Europe ( n = 9), and Asia ( n = 6).…”

“…Fourteen studies ( 11 , 22 – 24 , 30 – 36 , 38 , 40 , 42 ) reported the prevalence of SAPH by TTE. Among them, one study targeted a population with advanced sarcoidosis, among which the prevalence of SAPH by TTE was 29.7% ( 11 ).…”