Management strategies for pulmonary sarcoidosis.
SARCOIDOSIS IS A SYSTEMIC INFLAMMATORY CONDITION WITH AN UNEXPLAINED PREDILECTION FOR THE LUNG: over 90% of patients have radiographic or physiological abnormalities. Respiratory physicians therefore often manage patients, but any organ may be involved, with noncaseating granulomas the characteristic feature. Sarcoidosis is the commonest interstitial lung disease (ILD), differing from most other ILDs in that many patients remain asymptomatic or improve spontaneously. Careful baseline assessment of disease distribution and severity is thus central to initial management. Subsequently, the unpredictable clinical course necessitates regular monitoring. Sarcoidosis occurs worldwide, with a high prevalence in Afro-Caribbeans and those of Swedish or Danish origin. African Americans also tend to have severe disease. Oral corticosteroids have been used since the 1950s, with evidence of short to medium response; more recent studies have examined the role of inhaled steroids. Long-term benefits of steroids remain uncertain. International guidelines published in 1999 represent a consensus view endorsed by North American and European respiratory societies. Updated British guidelines on interstitial lung disease, including sarcoidosis, were published in 2008. This review describes current management strategies for pulmonary disease, including oral and inhaled steroids, commonly used alternative immunosuppressant agents, and lung transplantation. Tumor necrosis factor alpha inhibitors are briefly discussed.
Coker
Robina Kate
RK
Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, UK.
Am J Respir Crit Care Med. 2006 Oct 1;174(7):795-802
16840744
Sarcoidosis. 1985 Sep;2(2):107-13
3031790
Chest. 1985 Nov;88(5):687-90
4053710
Am J Respir Crit Care Med. 1997 Nov;156(5):1371-6
9372647
Chest. 2004 Mar;125(3):990-6
15006959
Chest. 1997 Mar;111(3):623-31
9118698
J Am Med Assoc. 1954 Oct 2;156(5):461-6
13201335
Sarcoidosis Vasc Diffuse Lung Dis. 1999 Mar;16(1):87-92
10207946
JAMA. 2002 Mar 13;287(10):1301-7
11886322
Chest. 2001 Sep;120(3):873-80
11555523
Thorax. 2008 Sep;63 Suppl 5:v1-58
18757459
Am J Respir Crit Care Med. 2001 Nov 15;164(10 Pt 1):1885-9
11734441
Eur Respir J. 2006 Sep;28(3):627-36
16946094
Arch Intern Med. 2003 Nov 24;163(21):2619-24
14638562
Ann Intern Med. 2002 Sep 3;137(5 Pt 2):435-78
12617574
Am J Respir Crit Care Med. 1999 Jul;160(1):192-7
10390399
Am J Respir Crit Care Med. 1997 May;155(5):1665-9
9154873
Thorax. 1988 Jul;43(7):516-24
2850637
Ann N Y Acad Sci. 1986;465:713-21
3014964
Sarcoidosis. 1986 Mar;3(1):40-6
3575916
Radiology. 2001 May;219(2):503-9
11323479
Chest. 1977 Mar;71(3):388-93
837754
Drug Ther Bull. 2009 Jan;47(1):9-12
19129430
Sarcoidosis Vasc Diffuse Lung Dis. 1998 Sep;15(2):150-7
9789893
Thorax. 1996 Mar;51(3):238-47
8779124
Tubercle. 1967 Dec;48(4):257-72
4872114
Chest. 2002 Jan;121(1):24-31
11796428
Eur Respir J. 1999 Nov;14(5):1117-22
10596700
Am J Respir Crit Care Med. 1999 Aug;160(2):736-55
10430755
Curr Opin Rheumatol. 2008 Mar;20(2):131-7
18349741
Sarcoidosis Vasc Diffuse Lung Dis. 1999 Mar;16(1):93-100
10207947
Chest. 1999 Aug;116(2):424-31
10453872
Thorax. 2006 Nov;61(11):980-5
16844727
Am J Med. 1952 Feb;12(2):139-60
14902863
Chest. 2005 Mar;127(3):1064-71
15764796
Medicine (Baltimore). 1976 Jan;55(1):39-65
173974
Sarcoidosis Vasc Diffuse Lung Dis. 2003 Mar;20(1):46-52
12737280
J Bone Miner Metab. 2004;22(1):48-52
14691687
Sarcoidosis Vasc Diffuse Lung Dis. 2000 Mar;17(1):60-6
10746262
Arthritis Rheum. 2001 Jul;44(7):1496-503
11465699
Osteoporos Int. 2005 Oct;16(10):1173-6
15983729
Lancet Oncol. 2006 Jun;7(6):508-14
16750501