Comorbidities of sarcoidosis

Abstract

Sarcoidosis is a heterogeneous disease, which can affect virtually every body organ, even though lungs and intra thoracic lymph nodes are almost universally affected. The presence of noncaseating granulomas is the histopathological hallmark of the disease, and clinical picture depends on the organs affected. Data about interaction between sarcoidosis and comorbidities, such as cardiovascular and pulmonary diseases, autoimmune disorders, malignancy and drug-related adverse events are limited. Several lung conditions can be associated with sarcoidosis, such as pulmonary hypertension and fibrosis, making it difficult sometimes the differentiation between complications and distinctive pathologies. Their coexistence may complicate the diagnosis of sarcoidosis and contribute to the highly variable and unpredictable natural history, particularly if several diseases are recognised. A thorough assessment of specific disorders that can be associated with sarcoidosis should always be carried out, and future studies will need to evaluate sarcoidosis not only as a single disorder, but also in the light of possible concomitant conditions. Key messages Comorbidities in sarcoidosis are common, especially cardiovascular and pulmonary diseases. In the diagnostic workup, a distinction must be made between sarcoidosis-related complaints and complaints caused by other separate disorders. It can be very difficult to distinguish between complications of sarcoidosis and other concomitant conditions. The coexistence of multiple conditions may complicate the diagnosis of sarcoidosis, affect its natural course and response to treatment.

Utility of Liquid-Based Cytology and Cell Block Procedure Obtained by Vitrectomy to Diagnose Ocular Sarcoidosis–The Significance of Epithelioid Granuloma and Epithelioid Cells

“…Systemic sarcoidosis is known to occur EG in several organs, including the lungs, lymph nodes, eyes, heart, and skin. 10 Ocular sarcoidosis is one of the initial manifestations of systemic sarcoidosis, and sarcoid uveitis is a major manifestation of ocular sarcoidosis. 2 For the treatment of patients with sarcoid uveitis, vitrectomy would be performed to remove vitreous opacity, and then vitreous body specimens and an intraocular IS were obtained.…”

Sarcoidosis: Updates on therapeutic drug trials and novel treatment approaches

“…For patients who develop new or worsening symptoms while on therapy, it is critical to consider and evaluate for other causes of these symptoms rather than routinely attributing worsening to failed therapy or to established progressive pulmonary or other organ sarcoidosis manifestation (80,81). Common sarcoidosis-related complications exhibiting overlapping symptoms requiring consideration include cardiac involvement with either arrhythmia or heart failure, sarcoidosis-associated pulmonary hypertension (SAPH), small fiber neuropathy, and CNS symptoms (80,82,83). Fatigue, depression, sleeplessness, physical deconditioning, and obstructive sleep apnea are also very common medication-related, sarcoidosis-related, or non-sarcoidosis-related co-morbidities that may drive the appearance of worsening disease (80)(81)(82)84).…”

“…Common sarcoidosis-related complications exhibiting overlapping symptoms requiring consideration include cardiac involvement with either arrhythmia or heart failure, sarcoidosis-associated pulmonary hypertension (SAPH), small fiber neuropathy, and CNS symptoms (80,82,83). Fatigue, depression, sleeplessness, physical deconditioning, and obstructive sleep apnea are also very common medication-related, sarcoidosis-related, or non-sarcoidosis-related co-morbidities that may drive the appearance of worsening disease (80)(81)(82)84). Entities contemporaneously seen in sarcoidosis that are crucial to consider are acute or sub-acute bacterial pneumonia, mycobacterial or mycotic infection, cardiovascular disease events common in the general population, and pulmonary embolism or lung and other cancers that have a higher temporal relationship to sarcoidosis than in the general population (85)(86)(87)(88)(89)(90)(91)(92)(93)(94)(95).…”

Sarcoidosis and autoimmunity: In the depth of a complex relationship

“…In this regard, Tana et al ( 31 ) stated that around one out of six patients with sarcoidosis could present an associated immune-mediated disease, among which autoimmune thyroid disorders, sjögren syndrome and ankylosing spondylitis are the most frequent; an association with familial Mediterranean fever, primary biliary cholangitis, hemolytic anemia, autoimmune hepatitis, antiphospholipid syndrome, immune thrombocytopenia, systemic sclerosis, psoriatic arthritis, and systemic lupus erythematosus was also described.…”