Course and prognosis of sarcoidosis

Sones, Maurice; Israel, Harold L.

doi:10.1016/0002-9343(60)90009-7

Cited by 124 publications

(50 citation statements)

References 13 publications

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“…A few develop a progressive form of the disease which may result in death [108]. In those patients undergoing resolution, subsequent biopsy or material examined at necropsy may reveal changes ranging from complete resolution with no scarring to focal pulmonary scars without evidence of granuloma formation.…”

Section: Clinical Featuresmentioning

confidence: 99%

“…In general, the more severe the clinical findings at the time of diagnosis and the more organ systems are affected by the disease, the more frequently adverse courses have been observed. Cutaneous sarcoid frequently indicates chronic and disseminated involvement and the prognosis, in general, is poor in patients with advanced skin lesions [10,108,109].…”

Section: Clinical Featuresmentioning

confidence: 99%

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Sarcoidosis: immunopathogenetic concepts and their clinical application

1998

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Our understanding of the immunopathogenesis of sarcoidosis has been advanced by studies of bronchoalveolar lavage cells. Activated macrophages and T-cells have been identified in different compartments of the sarcoid lung and the characteristics of the activation suggest that the cells become activated in the course of a normal immune response. The immune cells communicate via a cytokine network and the measuring of cytokine levels yields subgroups of sarcoidosis patients with different courses of the disease indicating different states of activation of the disease-mediating immune cells. The causative agent of sarcoidosis has not yet been identified; however, some of the described mechanisms can be clinically applied either to detect patients at risk of deterioration or to develop new therapeutic strategies. Using these approaches methotrexate, pentoxifylline and thalidomide have been identified as drugs which effectively suppress sarcoid inflammation and the serum level of soluble interleukin-2 receptors has been delineated to be a serum marker of sarcoid inflammation. Furthermore, analysing the pulmonary cytokine network in sarcoidosis will yield new staging parameters possibly supplying prognostic information and guiding therapeutic intervention.

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Section: Clinical Featuresmentioning

confidence: 99%

Section: Clinical Featuresmentioning

confidence: 99%

Sarcoidosis: immunopathogenetic concepts and their clinical application

1998

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“…Although the disease can be selflimiting, in patients with chronic disease (Ͼ2-year duration and/or skin involvement) spontaneous remissions seldom occur (3,4). For sarcoidosis patients with persistent or severe symptomatic disease, corticosteroids are the primary therapy.…”

Section: Introductionmentioning

confidence: 99%

Thalidomide Induces Granuloma Differentiation in Sarcoid Skin Lesions Associated with Disease Improvement

Oliver

Kikuchi

Krueger

et al. 2002

Clinical Immunology

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“…According to this author, the association with chronic bronchitis is an important aetiological factor. Out of 11 necropsies of sarcoid fibrosis, Sones and Israel (1960) observed four cases of chronic cor pulmonale (36%) ;Mayock et al (1963) noted three cases out of nine deaths. In our group, chronic cor pulmonale manifestations with or without right heart failure were observed in six out of 21 cases (28 6%).…”

Section: Methodsmentioning

confidence: 99%

Chronic cor pulmonale in pulmonary sarcoidosis

1978

Thorax

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pulmonale in pulmonary sarcoidosis. Right-heart overload happens relatively rarely in sarcoidosis, even with fibroemphysematous changes. Of 21 cases that we studied, six (28%) had clinical and/or electrocardiographic features of cor pulmonale. The cause of cor pulmonale often evoked is an invasion of the walls of pulmonary vessels by sarcoid granulomas or their compression by the fibrotic process. Pathological studies in one patient showed compression of large pulmonary arteries associated with specific sarcoid lesions in small and medium-sized arteries.The development of chronic cor pulmonale due to pulmonary hypertension has rarely been described in pulmonary sarcoidosis, even in chronic fibroemphysematous forms. The mechanisms often evoked to explain the occurrence of pulmonary hypertension are based on histological findings, the perivascular occurrence of granulomas with the fibrosis which sometimes results, and the possibility of thrombosis or invasion of arterial and vein walls by granulomas. Material and methodsTwenty-one cases of chronic sarcoidosis were studied.The diagnosis was made using clinical, radiological, pathological (bronchial biopsy), and immunological (Kveim test, tuberculin anergy) findings. Such a diagnosis was confirmed in life by these methods even in the two cases (2 and 5) where no definite evidence of sarcoidosis was found at necropsy many years later.The radiographic classification was based on postero-anterior and lateral views, occasionally confirmed by tomography.Evidence of right-sided heart involvement was based upon clinical examination and six electrocardiographic criteria (Schaub, 1966): 1 QRS vector angle in the frontal plane (angle a)>+900.2 Negative T wave in S2 and S3 or S, and ca. +900.3 S wave in V, and V >07 mV.4 R wave in V,+S wave in V5>1 mV.5 QRS direction to the right and posterior:rS of V1 to V4, sometimes rS or Qs of V1 to V6 with positive or flattened T waves.6 Incomplete right bundle-branch block: rS R' in V1 with R' in V1>10 mV. Radiological measurement of the size of the right heart chambers and the diameter of the pulmonary arteries was in most cases impossible because of the perihilar pulmonary opacities which obscured the cardiac and arterial contours. Thus radiological criteria were not taken into account.

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Course and prognosis of sarcoidosis

Cited by 124 publications

References 13 publications

Sarcoidosis: immunopathogenetic concepts and their clinical application

Sarcoidosis: immunopathogenetic concepts and their clinical application

Thalidomide Induces Granuloma Differentiation in Sarcoid Skin Lesions Associated with Disease Improvement

Chronic cor pulmonale in pulmonary sarcoidosis

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