The Diagnostic Pathway to Sarcoidosis*

Judson, Marc A.; Thompson, Bruce; Rabin, David L.; Steimel, Joanne; Knattereud, Genell L.; Lackland, Daniel T.; Rose, Cecile S.; Rańd, Cynthia S.; Baughman, Robert P.; Teirstein, Alvin S.

doi:10.1378/chest.123.2.406

Cited by 206 publications

(140 citation statements)

References 15 publications

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“…The diagnosis of sarcoidosis can be problematic (37). On average, patients have symptoms for more than 3 months before diagnosis and require three or more encounters with health care providers before the diagnosis can be established (38). Patients with sarcoidosis presenting with pulmonary symptoms often experience a delay in the diagnosis of sarcoidosis, as these symptoms are nonspecific, and alternative diagnoses such as asthma or bronchitis are often considered, thus causing the diagnostic postponement (39).…”

Section: Vitamin D Deficiency and The Risk Of Developing Sarcoidosismentioning

confidence: 99%

The role of vitamin D in multisystem sarcoidosis / Uloga vitamina D u sarkoidozi

Mihailović-Vučinić¹,

Ignjatović²,

Dudvarski-Ilić³

et al. 2012

Journal of Medical Biochemistry

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Summary: Recently published data indicate that vitamin D abnormalities are common in sarcoidosis patients. The purpose of this study was to compare serum vitamin 25(OH)D levels among sarcoidosis patients with different clinical courses of the disease. The study also included the first observations on cognitive functions (i.e. depression and fatigue syndrome) in relation to vitamin D deficiency in sarcoidosis patients. At the Biochemical Laboratory of the Clinical Center of Serbia, Belgrade, vitamin D25(OH)D was measured using the Elecsys ® Vitamin D total test. A total of 226 patients with biopsy-positive sarcoidosis were analyzed. The average median value of serum vitamin D was 9.47 mg/L, suggesting severe deficiency. Statistically significant correlation was found in patients with chronic disease and low levels of serum vitamin 25(OH)D (Chi-Square=6.044; df=2; p=0.014). The patient group with vitamin D serum levels higher than 20 mg/L showed higher levels of the mean forced vi tal capacity (FVC) by 380 mL, and forced expiratory volume in one second (FEV1) by 220 mL, when compared to the patient group with lower serum vitamin D. A statistically significant role was established for serum vitamin 25(OH)D levels as the predictor of fatigue (R 2 =0.878; p=0.038 (b=0.216)) and depression in patients with sarcoidosis (R 2 =0.80; p=0.000 (b=0.391)). The insufficiency of 25(OH)D seems to be an important factor in predicting the course of chronic disease, significant lung function impairments and cognitive failures such as fatigue and depression. The fact that the majo rity of the analyzed sarcoidosis patients had totally deficient serum 25(OH)D levels made this finding even more notable. Keywords: vitamin D, deficiency, sarcoidosisKratak sadr`aj: Nedavno objavljena istra`ivanja kod obole lih od sarkoidoze govore o ~estim abnormalnim vrednostima vitamina D. Cilj ove studije bio je da se uporedi nivo vita mina 25(OH)D kod obolelih od sarkoidoze sa razli~itim klini~kim tokom bolesti. Tako|e, ova studija predstavlja prva za pa `anja o vezi izme|u kognitivnih funkcija (odnosno ose}a ja depresije i zamora) i deficita vitamina D kod obolelih od sarko idoze. U Biohemijskoj laboratoriji Klini~kog centra Srbije vitamin D -25(OH)D meren je kori{}enjem testa Elec sys ® Vitamin D. Analizirano je 226 bolesnika sa sarkoidozom potvr|enom biopsijom. Prose~na srednja vrednost vitamina D u serumu bila je 9,47 mg/L, {to ukazuje na ozbiljan nedostatak. Statisti~ki zna~ajna korelacija na |e na je kod pa cije nata sa hroni~nom formom bolesti i niskim nivoom vitamina 25(OH)D u serumu (Xi-kvad rat=6,044; df=2; p=0,014). Grupa pacijenata sa nivoom vitamina D u serumu ve}im od 20 mg/L pokazuje ve}i nivo srednjeg for siranog vitalnog kapaciteta (FVC) za 380 mL i forsiranog ekspi ratornog volumena u prvoj sekundi (FEV1) za 220 mL u od nosu na grupu pacijenata sa ni`im nivoom D vitamina. Utvr|eno je da nivo vitamina 25(OH)D u serumu ima stati sti~ki zna~ajnu ulogu kao prediktor zamora i depresije kod obolelih od sarkoidoze. Insuficijencija 25(OH)D ...

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Section: Vitamin D Deficiency and The Risk Of Developing Sarcoidosismentioning

confidence: 99%

The role of vitamin D in multisystem sarcoidosis / Uloga vitamina D u sarkoidozi

Mihailović-Vučinić¹,

Ignjatović²,

Dudvarski-Ilić³

et al. 2012

Journal of Medical Biochemistry

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“…Given its multiple manifestations, diagnosis of sarcoidosis is often delayed, especially when the primary symptoms are pulmonary. 8 Uveitis in particular may precede other manifestations, and may be asymptomatic in up to one-third of affected patients, unlike typical acute uveitis. 9 As a general principle, the diagnosis requires demonstration of non-caseating granulomas affecting multiple organ systems, or at least typical pulmonary findings.…”

Section: Clinical Teaching Pointsmentioning

confidence: 99%

A Problematic Palsy: An Exercise in Clinical Reasoning

2015

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“…Diagnosis adheres to a diagnostic algorithm but is still problematic since it usually requires multiple examinations after patients have prolonged diagnosis by an average of three months [94]. A clinical presentation representative of sarcoidosis classical characteristics helps eliminate the statistical likelihood of other diseases; however, without a definitive diagnostic tool this currently serves as the best mechanism of diagnosis [60].…”

Section: Therapymentioning

confidence: 99%

Sarcoidosis: Unknown Etiology and Genetic Predisposition Provides Therapeutic Challenges

Rotsinger

Drake²

2014

J Pulm Respir Med

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Sarcoidosis is an idiopathic multisystem disorder characterized by noncaseating epithelioid granulomas predominately affecting lungs and lymph nodes, but with potential to affect any organ system. Sarcoidosis shares similarities in development to other infectious granulomatous diseases, such as berylliosis and tuberculosis; however, its elusive etiology and non-distinctive histology have provided many diagnostic challenges. Evidence of a transferrable antigen combined with a high incidence rate in the lungs has focused efforts primarily on antigens with airborne transmissibility. While Mycobacterium tuberculosis and Propionibacterium acnes have provided strong associations to implicate each as a contributor to sarcoidosis pathogenesis, detection challenges remain and consensus of a definitive antigen is lacking.

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The Diagnostic Pathway to Sarcoidosis*

Cited by 206 publications

References 15 publications

The role of vitamin D in multisystem sarcoidosis / Uloga vitamina D u sarkoidozi

The role of vitamin D in multisystem sarcoidosis / Uloga vitamina D u sarkoidozi

A Problematic Palsy: An Exercise in Clinical Reasoning

Sarcoidosis: Unknown Etiology and Genetic Predisposition Provides Therapeutic Challenges

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