Treatment of Sarcoidosis: Grading the evidence.

Treatment of Sarcoidosis: Grading the evidence. Expert Rev Clin Pharmacol. 2018 Jun 08;: Authors: James WE, Baughman R Abstract INTRODUCTION: Treatment of sarcoidosis recommendations are often based on clinical experience and expert opinion. However, there are an increasing number of studies which are providing evidence to support decisions regarding treatment. Areas Covered: Several studies have identified factors associated with increased risk for organ failure or death ("danger"). There have been several studies focused on the role of treatment to improve quality of life for the patient. Sarcoidosis treatment often follows a progression, based on response. Corticosteroids remain the initial treatment of choice for most patients. Second line therapy includes cytotoxic agents. Immunosuppressives such as methotrexate, azathioprine, leflunomide, and mycophenolate have all been reported as effective in sarcoidosis. Biologics and other agents are third line therapy. The monoclonal antibodies directed against tumor necrosis factor have been shown to be particularly effective for advanced disease. Infliximab has been the most studied drug in this class. Newer treatments, including repository corticotropin injection and rituximab have been reported as effective in some cases. Expert Commentary: In this review, we use the GRADE system to evaluate the currently available evidence and make recommendations regarding treatment. PMID: 29883224 [PubMed -...
Source: Expert Review of Clinical Pharmacology - Category: Drugs & Pharmacology Tags: Expert Rev Clin Pharmacol Source Type: research

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Authors: Kaida T, Inomata T, Minami Y, Yazaki M, Fujita T, Iida Y, Ikeda Y, Nabeta T, Ishii S, Naruke T, Maekawa E, Koitabashi T, Ako J Abstract Our aim is to clarify the factors for early diagnosis of cardiac sarcoidosis (CS) in patients with complete atrioventricular block (CAVB) and its impact on cardiac function after corticosteroid therapy.A total of 15 CS patients with CAVB who underwent corticosteroid therapy were retrospectively analyzed. Patients were divided into two groups according to the time from the first CAVB onset to the diagnosis of CS. Clinical characteristics and outcomes were compared between t...
Source: International Heart Journal - Category: Cardiology Tags: Int Heart J Source Type: research
Authors: Ahmadzai H, Huang S, Steinfort C, Markos J, Allen RK, Wakefield D, Wilsher M, Thomas PS Abstract Sarcoidosis is a systemic disease of unknown aetiology, characterised by non-caseating granulomatous inflammation. It most commonly manifests in the lungs and intrathoracic lymph nodes but can affect any organ. This summary of an educational resource provided by the Thoracic Society of Australia and New Zealand outlines the current understanding of sarcoidosis and highlights the need for further research. Our knowledge of the aetiology and immunopathogenesis of sarcoidosis remains incomplete. The enigma of sarc...
Source: Medical Journal of Australia - Category: General Medicine Tags: Med J Aust Source Type: research
Predominant or isolated right ventricular involvement in cardiac sarcoidosis is uncommon, but should always be considered in a case of right ventricular hypertrophy combined with ventricular arrhythmia and/or conduction disturbance. Although improvement in right ventricular hypertrophy and atrioventricular conduction disturbance following corticosteroid therapy has been reported, the detailed serial electrocardiographic responses during corticosteroid therapy, as well as temporal changes in the electrocardiographic, biochemical, and morphological responses, have not been reported.
Source: Journal of Electrocardiology - Category: Cardiology Authors: Source Type: research
Publication date: Available online 3 April 2018 Source:The Lancet Respiratory Medicine Author(s): Paolo Spagnolo, Giulio Rossi, Rocco Trisolini, Nicola Sverzellati, Robert P Baughman, Athol U Wells Sarcoidosis is a granulomatous disease of unknown cause, occurs worldwide and has a highly variable prevalence. The disease is typically dominant in the lungs, although it can affect virtually any organ and is unpredictable in its clinical course. The severity of pulmonary sarcoidosis ranges from incidentally discovered radiographic abnormalities in asymptomatic patients to a chronic progressive disease that is refractory to tr...
Source: The Lancet Respiratory Medicine - Category: Respiratory Medicine Source Type: research
Purpose of review Sarcoidosis is a systemic disease characterized by noncaseating granulomatous inflammation of multiple organ systems. Pulmonary, cardiac, and neurologic involvements have the worst prognosis. Current recommendations for the therapeutic management and follow-up of sarcoidosis involving these critical organs will be reviewed. Recent findings In those sarcoidosis patients requiring immunosuppressive therapy, corticosteroids are used first at varying doses depending on the presenting manifestation. Patients with symptomatic pulmonary, cardiac, or neurologic involvement will be maintained on corticosteroi...
Source: Current Opinion in Rheumatology - Category: Rheumatology Tags: CLINICAL THERAPEUTICS: Edited by William J. McCune Source Type: research
Conclusion This nationwide study of muscular sarcoidosis allowed the identification of 4 patterns of granulomatous myositis, which differed by phenotypes and the clinical course.
Source: Neurology Neuroimmunology and Neuroinflammation - Category: Neurology Authors: Tags: All Neuromuscular Disease, Cohort studies Article Source Type: research
This article begins with an illustrative case vignette, followed by an overview of the syndrome and current theories regarding its pathogenesis.
Source: American Journal of Kidney Diseases - Category: Urology & Nephrology Source Type: research
Authors: Abad S, Héran F, Terrada C, Bielefeld P, Sène D, Trad S, Saadoun D, Sève P Abstract Inflammatory orbitopathies relate to an inflammatory state originating within the orbit and its adnexes, except the inner ocular globe. Orbital inflammation (OI) may be either localized manifestation of a proven or like autoimmune disease, or local response from immune system against infectious, structural or tumoral antigens. We review the clinical manifestations of OI, which provide helpful clues to the diagnosis and describe the inflammatory, infectious and neoplastic conditions classically associate...
Source: Revue de Medecine Interne - Category: Internal Medicine Tags: Rev Med Interne Source Type: research
A 43-year-old, never-smoking, African-American female was referred to our outpatient clinic for progressive dyspnoea. She had a medical history of sarcoidosis with lymph-node, pulmonary, skin and ocular involvement. Diagnosis was based on a previously conducted chest high-resolution computed tomography (CT) that showed bilateral hilar and mediastinal lymphadenopathy containing calcifications and multiple small lung nodules with peri-lymphatic distribution along the pleura and fissures A histological analysis of biopsy specimens from a lymph node located in the left side of the neck revealed large granulomas with multinucle...
Source: European Respiratory Journal - Category: Respiratory Medicine Authors: Tags: Interstitial and orphan lung disease Original Articles: Correspondence Source Type: research
Isolated intraspinal neurosarcoidosis is a rare clinical entity, with most reports describing intramedullary involvement in adults. We detail the case of a nine-year-old girl with rapid onset compressive myelopathy secondary to a thoracic epidural lesion. Although pathological diagnosis was challenging, a presumptive diagnosis of isolated extradural neurosarcoidosis was made in light of the patient ’s investigations and dramatic response to corticosteroids. Though less likely than neoplasia, rheumatologic processes such as inflammatory granulomatous disease warrant consideration in similar cases.
Source: World Neurosurgery - Category: Neurosurgery Authors: Tags: Case Report Source Type: research
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