Sarcoidosis in the aged: review and management.
OBJECTIVE
We intend to update the data of various clinical features and management of sarcoidosis in the aged.


RESULTS
Subclinical or inapparent systemic involvement of sarcoidosis was found at autopsy in elderly patients who died from sarcoidosis, complication of malignancy, or cerebrovascular accidents. Sarcoidosis in the aged presents with unusual intrathoracic and extrapulmonary clinical features. Occasionally, these features may masquerade as malignancy. Sarcoidosis may appear or reactivate in patients receiving treatment with tumor necrosis factor antagonists or antiviral treatment. In elderly patients, antitumour necrosis factor treatment is effective for refractory sarcoidosis, methylphenidate hydrochloride for fatigue, and bosentan for sarcoidosis-associated pulmonary hypertension. Inhaled prostacyclin has been found to be effective in some patients with pulmonary hypertension. Sarcoidosis and malignancy can coexist.


CONCLUSIONS
Autopsy studies revealed that both apparent and subclinical or inapparent systemic involvement of sarcoidosis might exist in aged patients with sarcoidosis. Aged sarcoidosis patients often present with unusual clinical features of sarcoidosis. Occasionally, these features resemble malignancy. New treatment with tumor necrosis factor antagonists for intractable sarcoidosis, methylphenidate hydrochloride for fatigue, and bosentan for sarcoidosis-associated pulmonary hypertension may be effective in sarcoidosis in the aged. Sarcoidosis and malignancy may coexist.
Tachibana
Teruo
T
Department of Internal Medicine, Aizenbashi Hospital, Osaka, Japan. tachi@zeus.eonet.ne.jp
Iwai
Kazuo
K
Takemura
Tamiko
T
D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000077300:Bosentan; D006801:Humans; D015994:Incidence; D008774:Methylphenidate / Q000627:therapeutic use; D017565:Sarcoidosis, Pulmonary / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology*; D013449:Sulfonamides / Q000627:therapeutic use; D016896:Treatment Outcome; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors
D013449:Sulfonamides; D014409:Tumor Necrosis Factor-alpha; D008774:Methylphenidate; D000077300:Bosentan