Comprehensive Care for Patients with Sarcoidosis

Abstract

Sarcoidosis is a multisystem granulomatous disease, associated with significant morbidity and impaired quality of life. Treatment is aimed at recovering organ function, reducing symptom burden and improving quality of life. Because of the heterogeneity and variable disease course, a comprehensive, multidisciplinary approach to care is needed. Comprehensive care includes not only pharmacological interventions, but also supportive measures aimed at relieving symptoms and improving quality of life. The purpose of this review is to summarize the most recent knowledge regarding different aspects of care and propose a structured approach to sarcoidosis management.

How to Tackle the Diagnosis and Treatment in the Diverse Scenarios of Extrapulmonary Sarcoidosis

“…A comprehensive care for extrapulmonary sarcoidosis is based not only on diseasemodifying drugs aimed at controlling the granulomatous process (also called antisarcoidosis or anti-inflammatory drugs) but also on organ-directed treatments (e.g., implantable cardiac defibrillator) and also supportive treatments aimed at relieving symptoms and improving quality of life [10]. Applying the ABCDE method is recommended [10]. 2.…”

“…• For patients with initial extrapulmonary manifestations, how to look for criteria for a confident sarcoidosis diagnosis? • In all cases, how to assess the clinical impact of extrapulmonary localizations on symptoms, organ function, follow-up, and treatment management [10,11]?…”

Management of Sarcoidosis, a Selection of Topical Items Updating

“…In the area of clinical knowledge of sarcoidosis, classical reviews are still not outdated [ 27 , 28 , 29 ]. However, this knowledge is continuously proceeding by small touches, as illustrated by Catharina Moor’s paper, the main interest of which is to give a global picture of care of sarcoidosis patients, not limited to treatment via anti-sarcoidosis drugs but addressing all aspects of the disease, from clinical to economic and social life, thanks to the use of an ABCDE model (assess/backing/complaints and comorbidities/disease-modifying treatment/extrapulmonary specialists), without minimizing the unresolved questions concerning both the cause and best medical treatment of sarcoidosis [ 30 , 31 ]. Apart from well-known severe complications causing organ dysfunction and premature death [ 32 , 33 ], Quality of life (QOL) impairment, notably due to fatigue, depression, cognitive impairment, small-nerve neuropathy, familial and occupational life or due to reduced income, which have been insufficiently taken into account for a long time, are better recognized, as is the impact on familial partners.…”

“…Sarcoidosis is a multifaceted disease with variable presentations according to epidemiology, organs involved, duration and severity, often associated with impaired quality of life due to symptoms, para-sarcoidosis syndromes and treatment adverse events. A comprehensive care is particularly indicated [ 30 ]. Therapeutic decisions need to be well-balanced, taking into account not only morbidity induced with organ dysfunction and vital risks but also patients’ expectations, particularly concerning QOL and symptoms, as shown by a recent study [ 34 ].…”

“…Schematically, there are several kinds of treatment, using disease-modifying drugs or supportive measures. In most patients, pulmonary manifestations are at the forefront, but often extrapulmonary ones need to be taken into account, with multidisciplinary discussion [ 30 ]. There are still many unexplored points, such as comparisons between different regimen doses and even different molecules as first-line treatments, while corticosteroid remains for now the only recommended initial treatment.…”