SummaryBackgroundUntil now, a proper biomarker(s) to evaluate sarcoidosis activity has not been recognized. The aims of this study were to evaluate the sensitivity and specificity of the two biomarkers of sarcoidosis activity already in use (serum angiotensin converting enzyme – ACE and serum chitotriosidase) in a population of 430 sarcoidosis patients. The activities of these markers were also analyzed in a group of 264 healthy controls.MethodsFour hundred and thirty biopsy positive sarcoidosis patients were divided into groups with active and inactive disease, and groups with acute or chronic disease. In a subgroup of 55 sarcoidosis patients, activity was also assessed by F-18 fluorodeoxyglucose positron emission tomography (18F-FDG-PET) scanning. Both serum chitotriosidase and ACE levels showed non-normal distribution, so nonparametric tests were used in statistical analysis.ResultsSerum chitotriosidase activities were almost 6 times higher in patients with active sarcoidosis than in healthy controls and inactive disease. A serum chitotriosidase value of 100 nmol/mL/h had the sensitivity of .5% and specificity of 70.0%. A serum ACE activity cutoff value of 32.0 U/L had the sensitivity of 66.0% and the specificity of 54%. A statistically significant correlation was obtained between the focal granulomatous activity detected on 18F-FDG PET/CT and serum chitotriosidase levels, but no such correlation was found with ACE. The levels of serum chitotriosidase activity significantly correlated with the disease duration (P < 0.0001). Also, serum chitotriosidase significantly correlated with clinical outcome status (COS) categories (ρ =0.272, P =0.001).ConclusionsSerum chitotriosidase proved to be a reliable biomarker of sarcoidosis activity and disease chronicity.

Sarcoidosis significantly reduces patients' health status, both independently and also due to increased BMI. Reduction in BMI may contribute to improved spirometry results and health status of patients with sarcoidosis.

Objective: The aim of this study was to use a Serbian-language version of the disease-specific, self-report Sarcoidosis Health Questionnaire (SHQ), which was designed and originally validated in the United States, to assess health status in sarcoidosis patients in Serbia, as well as validating the instrument for use in the country. Methods: This was a cross-sectional study of 346 patients with biopsy-confirmed sarcoidosis. To evaluate the health status of the patients, we used the SHQ, which was translated into Serbian for the purposes of this study. We compared SHQ scores by patient gender and age, as well as by disease duration and treatment. Lower SHQ scores indicate poorer health status. Results: The SHQ scores demonstrated differences in health status among subgroups of the sarcoidosis patients evaluated. Health status was found to be significantly poorer among female patients and older patients, as well as among those with chronic sarcoidosis or extrapulmonary manifestations of the disease. Monotherapy with methotrexate was found to be associated with better health status than was monotherapy with prednisone or combination therapy with prednisone and methotrexate. Conclusions: The SHQ is a reliable, disease-specific, self-report instrument. Although originally designed for use in the United States, the SHQ could be a useful tool for the assessment of health status in various non-English-speaking populations of sarcoidosis patients.

Summary: Recently published data indicate that vitamin D abnormalities are common in sarcoidosis patients. The purpose of this study was to compare serum vitamin 25(OH)D levels among sarcoidosis patients with different clinical courses of the disease. The study also included the first observations on cognitive functions (i.e. depression and fatigue syndrome) in relation to vitamin D deficiency in sarcoidosis patients. At the Biochemical Laboratory of the Clinical Center of Serbia, Belgrade, vitamin D25(OH)D was measured using the Elecsys ® Vitamin D total test. A total of 226 patients with biopsy-positive sarcoidosis were analyzed. The average median value of serum vitamin D was 9.47 mg/L, suggesting severe deficiency. Statistically significant correlation was found in patients with chronic disease and low levels of serum vitamin 25(OH)D (Chi-Square=6.044; df=2; p=0.014). The patient group with vitamin D serum levels higher than 20 mg/L showed higher levels of the mean forced vi tal capacity (FVC) by 380 mL, and forced expiratory volume in one second (FEV1) by 220 mL, when compared to the patient group with lower serum vitamin D. A statistically significant role was established for serum vitamin 25(OH)D levels as the predictor of fatigue (R 2 =0.878; p=0.038 (b=0.216)) and depression in patients with sarcoidosis (R 2 =0.80; p=0.000 (b=0.391)). The insufficiency of 25(OH)D seems to be an important factor in predicting the course of chronic disease, significant lung function impairments and cognitive failures such as fatigue and depression. The fact that the majo rity of the analyzed sarcoidosis patients had totally deficient serum 25(OH)D levels made this finding even more notable. Keywords: vitamin D, deficiency, sarcoidosisKratak sadr`aj: Nedavno objavljena istra`ivanja kod obole lih od sarkoidoze govore o ~estim abnormalnim vrednostima vitamina D. Cilj ove studije bio je da se uporedi nivo vita mina 25(OH)D kod obolelih od sarkoidoze sa razli~itim klini~kim tokom bolesti. Tako|e, ova studija predstavlja prva za pa `anja o vezi izme|u kognitivnih funkcija (odnosno ose}a ja depresije i zamora) i deficita vitamina D kod obolelih od sarko idoze. U Biohemijskoj laboratoriji Klini~kog centra Srbije vitamin D -25(OH)D meren je kori{}enjem testa Elec sys ® Vitamin D. Analizirano je 226 bolesnika sa sarkoidozom potvr|enom biopsijom. Prose~na srednja vrednost vitamina D u serumu bila je 9,47 mg/L, {to ukazuje na ozbiljan nedostatak. Statisti~ki zna~ajna korelacija na |e na je kod pa cije nata sa hroni~nom formom bolesti i niskim nivoom vitamina 25(OH)D u serumu (Xi-kvad rat=6,044; df=2; p=0,014). Grupa pacijenata sa nivoom vitamina D u serumu ve}im od 20 mg/L pokazuje ve}i nivo srednjeg for siranog vitalnog kapaciteta (FVC) za 380 mL i forsiranog ekspi ratornog volumena u prvoj sekundi (FEV1) za 220 mL u od nosu na grupu pacijenata sa ni`im nivoom D vitamina. Utvr|eno je da nivo vitamina 25(OH)D u serumu ima stati sti~ki zna~ajnu ulogu kao prediktor zamora i depresije kod obolelih od sarkoidoze. Insuficijencija 25(OH)D ...

Recently published data indicate that vitamin D abnormalities are common in sar coidosis patients. The purpose of this study was to compar e serum vitamin 25(OH)D levels among sarcoidosis patients with differ ent clinical courses of the disease. The study also included the first obser vations on cognitive functions (i.e. depr ession and fatigue syndrome) in r elation to vitamin D deficiency in sar coidosis patients. At the Biochemical Laboratory of the Clinical Center of Serbia, Belgrade, vitamin D25(OH)D was measur ed using the Elecsys ® Vitamin D total test. A total of 226 patients with biopsy-positive sarcoidosis were analyzed. The average median value of ser um vitamin D was 9.47 mg/L, suggesting severe deficiency. Statistically significant cor relation was found in patients with chronic disease and low levels of serum vitamin 25(OH)D (Chi-Squar e=6.044; df=2; p=0.014). The patient group with vitamin D serum levels higher than 20 mg/L showed higher levels of the mean for ced vi tal capacity (FVC) by 380 mL, and for ced expiratory volume in one second (FEV1) by 220 mL, when compared to the patient group with lower serum vitamin D. A statistically significant role was established for serum vitamin 25(OH)D levels as the pr edictor of fatigue (R 2 =0.878; p=0.038 (b=0.216)) and depression in patients with sar coidosis (R 2 =0.8 0; p=0.000 (b=0.391)). The insufficiency of 25(OH)D seems to be an important factor in pr edicting the course of chr onic disease, significant lung function impair ments and cognitive failur es such as fatigue and depr ession. The fact that the majo rity of the analyzed sarcoidosis patients had totally deficient ser um 25(OH)D levels made this finding even mor e notable.