The effects of pharmacological interventions on quality of life and fatigue in sarcoidosis: a systematic review

Vis, Roeland; Garde, E.M.W. van de; Grutters, Jan C.; Korenromp, Ingrid H.E.

doi:10.1183/16000617.0057-2019

Cited by 17 publications

(13 citation statements)

References 31 publications

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“…Medical therapeutic options for such systemic conditions are often limited, reflecting the complex nature and heterogeneous pathophysiologic origins [33]. Limited data in the medical literature have shown a beneficial effect of PR intervention among individuals with sarcoidosis resulting in an improvement of fatigue and dyspnea symptoms as well as improved exercise capacity and quality of life.…”

Section: Discussion/conclusionmentioning

confidence: 99%

The Short- and Long-Term Impact of Pulmonary Rehabilitation in Subjects with Sarcoidosis: A Prospective Study and Review of the Literature

et al. 2021

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Background: Sarcoidosis is a heterogeneous multisystemic disorder of unknown etiology. Dyspnea and fatigue are two of the most common and debilitating symptoms experienced by subjects with sarcoidosis. There is limited evidence regarding the short- and long-term impact of pulmonary rehabilitation (PR) on exercise capacity and fatigue in these individuals. Objective: To evaluate the benefit of PR in subjects with pulmonary sarcoidosis at different severity stages and to review the current literature about PR in sarcoidosis. Methods: PR included a 12-week training program of a twice-weekly 90-min workouts. Fifty-two subjects with stable pulmonary sarcoidosis were recruited. Maximal exercise capacity, defined as VO2max, was measured using the cardiopulmonary exercise test (CPET). Pulmonary function tests, 6-min walking distance (6MWD), St. George’s Respiratory Questionnaire (SGRQ), and the modified Medical Research Council (mMRC) and Hospital Anxiety and Depression Scale (HADS) questionnaires were given before and after PR and following 6 months (follow-up). Results: The PR program significantly increased the VO2max (1.8 ± 2.3 mL/kg/min, p = 0.002), following 12 weeks. mMRC and SGRQ scores were also improved (−0.3 ± 0.8, p = 0.03, and −3.87 ± 10.4, p = 0.03, respectively). The impact of PR on VO2max was more pronounced in subjects with pulmonary parenchymal involvement. The increase in VO2max correlated with initial disease severity (indicated by FEV1/FVC, p = 0.01). Subjects with FEV1/FVC <70% showed greater improvement in 6MWD. 6MWD also improved in those with a transfer coefficient of the lung for CO (KCO) above 80% predicted (p < 0.05). At 6-month follow-up, the VO2max, 6MWD, and SGRQ scores remained stable, thus suggesting lasting effects of PR. Conclusion: PR is a promising complementary therapeutic intervention for subjects with sarcoidosis. Further study is needed to validate these findings.

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Section: Discussion/conclusionmentioning

confidence: 99%

The Short- and Long-Term Impact of Pulmonary Rehabilitation in Subjects with Sarcoidosis: A Prospective Study and Review of the Literature

et al. 2021

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“…GCs may offer benefits in newly diagnosed, symptomatic, untreated patients, but in those already treated and clinically stabilized, an increase in daily dose of GCs and/or addition of other drugs may often not be useful. Some small trials with stimulants have found them well tolerated and effective [85].…”

Section: Management Of Eye Neurological and Cardiac Sarcoidosismentioning

confidence: 99%

A Comprehensive Review of Sarcoidosis Treatment for Pulmonologists

et al. 2021

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Due to frequent lung involvement, the pulmonologist is often the reference physician for management of sarcoidosis, a systemic granulomatous disease with a heterogeneous course. Treatment of sarcoidosis raises some issues. The first challenge is to select patients who are likely to benefit from treatment, as sarcoidosis may be self-limiting and remit spontaneously, in which case treatment can be postponed and possibly avoided without any significant impact on quality of life, organ damage or prognosis. Systemic glucocorticosteroids (GCs) are the drug of first choice for sarcoidosis. When GCs are started, there is a [ 50% chance of long-term treatment. Prolonged use of prednisone at [ 10 mg/day or equivalent is often associated with severe side effects. In these and refractory cases, steroid-sparing options are advised. Antimetabolites, such as methotrexate, are the second-choice therapy. Biologics, such as anti-TNF and especially infliximab, are third-choice drugs. The three treatments can be used concomitantly. Regardless of whether treatment is started, the clinician needs to organize regular follow-up to monitor remissions, flares, progression, complications, toxicity and relapses in order to promptly adjust the drugs used.

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“…However, fatigue is common in all chronic disorders, for instance, chronic obstructive pulmonary disease, liver disease, rheumatic diseases, sarcoidosis, cancer, hematologic diseases, and many others. 1,[8][9][10][11][12][13] Thus, while many published papers assess fatigue as a unique feature of a specific disease (eg, the literature contains many references to cancer-related fatigue [CRF]), we believe central fatigue is a feature common to many if not all chronic diseases.…”

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confidence: 99%

“…6,13,14 Thus, one must conclude that fatigue can be improved by treatment of the underlying condition only to a minor degree. 10,14 There are studies that exercise may improve fatigue in most chronic disorders, but prospective, randomized studies are necessary to confirm this in CIDP. 8,11,12 Many other items that are related to and impact fatigue but are not specific to the disease in question are known, including age, gender, obstructive sleep apnea, poor sleep, depression, anxiety, personality type, and life experiences.…”

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confidence: 99%

“…Since fatigue is a non‐specific symptom of multiple chronic diseases, it is not unexpected that correlations of fatigue with objective disease signs and/or laboratory tests are uncommon and when found are weak 6,13,14 . Thus, one must conclude that fatigue can be improved by treatment of the underlying condition only to a minor degree 10,14 . There are studies that exercise may improve fatigue in most chronic disorders, but prospective, randomized studies are necessary to confirm this in CIDP 8,11,12 .…”

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confidence: 99%

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