title: Elderly-onset sarcoidosis: prevalence, clinical course, and treatment.
abstract: Sarcoidosis is a systemic disorder of unknown cause characterized by its pathological hallmark, the non-caseating granulomas, and by variable clinical course. While most of the cases affect people aged between 25 and 40 years, approximately 30 % of cases occur in older patients. Elderly-onset sarcoidosis (EOS) is defined as the onset of sarcoidosis in people over 65 years of age. Specific studies on the incidence and prevalence of sarcoidosis in this subgroup are scarce. Several studies suggest that the clinical features of EOS differ from those of sarcoidosis in younger patients. Compared with younger patients, fatigue, uveitis and specific skin lesions are more common, while erythema nodosum and chest x-ray abnormalities are less frequent. The diagnosis of EOS is challenging and may be delayed for many months because of its insidious onset, low prevalence and similarity to other more common disorders. When there is a granulomatous reaction in the elderly, clinicians should doubt the diagnosis and first think of tuberculosis, neoplasia or rare settings such as granulomatosis with polyangiitis or granulomatous reaction due to interferon and tumour necrosis factor-α (TNFα) blockers. A minor salivary gland biopsy also has a higher accuracy for diagnosis in the elderly. The current management of EOS remains empiric because of the lack of randomized, controlled studies. However, the approach to treatment is similar, regardless of the age of the patient. The treatment may be complicated by co-morbidities and increased risk of toxicities from usual treatments, particularly steroids. This review discusses the epidemiology, clinical course, prognosis and treatment of EOS.
authors.affiliation: Department of Internal Medicine, Hopital de la Croix-Rousse, Claude Bernard University Lyon I, 103 Grande rue de la Croix-Rousse, 69004, Lyon, France.
authors.forename: Yvan
authors.initials: Y
authors.lastname: Jamilloux
authors.forename: Marc
authors.initials: M
authors.lastname: Bonnefoy
authors.forename: Dominique
authors.initials: D
authors.lastname: Valeyre
authors.forename: Loig
authors.initials: L
authors.lastname: Varron
authors.forename: Christiane
authors.initials: C
authors.lastname: Broussolle
authors.forename: Pascal
authors.initials: P
authors.lastname: Sève
mesh_terms: D000305:Adrenal Cortex Hormones / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D003937:Diagnosis, Differential; D018572:Disease-Free Survival; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D017410:Practice Guidelines as Topic; D015995:Prevalence; D012507:Sarcoidosis / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors
chemical_list: D000305:Adrenal Cortex Hormones; D007166:Immunosuppressive Agents; D014409:Tumor Necrosis Factor-alpha