Differences in symptom severity and health status impairment between patients with pulmonary and pulmonary plus extrapulmonary sarcoidosis

Gvozdenovic, Branislav; Mihailović-Vučinić, Violeta; Ilic-Dudvarski, Aleksandra; Zugic, Vladimir; Judson, Marc A.

doi:10.1016/j.rmed.2008.05.001

Cited by 61 publications

(57 citation statements)

References 18 publications

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“…It was shown that those patients with pulmonary and extrapulmonary sarcoidosis reported higher fatigue levels than those with only the lungs affected. This has also been shown by Gvozdenovic et al 11 and suggests a possible additive effect to the symptom of fatigue. Furthermore, not only the lo- calization but also the burden of the disease, seen as numbers of affected organs, showed an influence on the level of fatigue, as patients with 3 or more affected organs reported significantly more fatigue than those with fewer than 3 affected organs.…”

Section: Discussionsupporting

confidence: 75%

“…10 The affected organs might be of critical importance since patients with pulmonary and extrapulmonary disseminated sarcoidosis have higher fatigue levels than patients with pulmonary sarcoidosis. 11 Comorbidity may contribute to fatigue levels. Examples include restless legs syndrome, which leads to disturbed and superficial sleep with subsequent fatigue, insomnia, and daytime somnolence.…”

Section: Introductionmentioning

confidence: 99%

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Factors Associated With Fatigue in Sarcoidosis

Fleischer¹,

Hinz²,

Brähler³

et al. 2013

Respir Care

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BACKGROUND: Fatigue is a frequent symptom of patients with sarcoidosis. The origin of fatigue associated with sarcoidosis is unclear. The aim of this study was to assess the impact of affected organs, medication, and comorbidity on fatigue related to sarcoidosis. METHOD: In collaboration with the German Sarcoidosis Society, a sample of 1,197 subjects diagnosed with sarcoidosis was examined. The participants completed a questionnaire that contained the Fatigue Assessment Scale and the Multidimensional Fatigue Inventory. RESULTS: In this study, muscles, bones, and nerves were most strongly associated with fatigue. Patients receiving prednisolone showed heightened fatigue levels. However, the association between the duration of prednisolone therapy and fatigue was weak. The concomitant diseases, pulmonary hypertension and sleep apnea, showed the greatest impact elevating fatigue (effect sizes d > 0.50). In the combined regression analysis, comorbidity was the most important predictor of fatigue. CONCLUSIONS: It is important to consider that multiple clinical factors, especially comorbidities, contribute to the high degrees of fatigue in sarcoidosis.

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Section: Discussionsupporting

confidence: 75%

Section: Introductionmentioning

confidence: 99%

Factors Associated With Fatigue in Sarcoidosis

Fleischer¹,

Hinz²,

Brähler³

et al. 2013

Respir Care

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“…The level of fatigue is similar in studies comparing European to U.S. patients, even though the clinical features and treatment of these two groups was different (108). Fatigue was demonstrated to be more severe in patients with pulmonary disease plus extrapulmonary disease than in those with pulmonary disease alone (109). Fatigue can affect overall patient health.…”

Section: Therapymentioning

confidence: 99%

A Concise Review of Pulmonary Sarcoidosis

Baughman

Culver²,

Judson

2011

Am J Respir Crit Care Med

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432

330

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This is an update on sarcoidosis, focusing on etiology, diagnosis, and treatment. In the area of etiopathogenesis, we now have a better understanding of the immune response that leads to the disease as well as genetic factors that modify both the risk for the disease and its clinical outcome. Several groups have also identified possible agents as a cause for sarcoidosis. Although none of these potential causes has been definitely confirmed, there is increasing evidence to support that one or more infectious agents may cause sarcoidosis, although this organism may no longer be viable in the patient. The diagnosis of sarcoidosis has been significantly aided by new technology. This includes the endobronchial ultrasound, which has been shown to increase the yield of needle aspiration of mediastinal and hilar lymph nodes. The positive emission tomography scan has proven useful for selecting possible biopsy sites by identifying organ involvement not appreciated by routine methodology. It has also helped in assessing cardiac involvement. The biologic agents, such as the anti-tumor necrosis factor antibodies, have changed the approach to refractory sarcoidosis. There is increasing evidence that the clinician can identify which patient is most likely to benefit from such therapy. As new and more potent antiinflammatory agents have been developed, it is clear that there are other factors that burden the patient with sarcoidosis, including fatigue and sarcoidosis-associated pulmonary hypertension. There have been several recent studies demonstrating treatment options for these problems.

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“…Extrapulmonary sarcoidosis may be on occasion life threatening and may also affect the therapeutic approach 9 . There is also evidence that patients with pulmonary plus extrapulmonary sarcoidosis are more impaired in the severity of symptoms, restrictions of activities of daily living and there is also impairment of health status comparing to the patients with isolated pulmonary sarcoidosis 10 . One may therefore expect that pulmonary sarcoidosis differ in clinical and laboratory parameters from those patients with accompanied extrapulmonary sarcoidosis.…”

Section: Introductionmentioning

confidence: 99%

Extrapulmonary involvement in patients with sarcoidosis and comparison of routine laboratory and clinical data to pulmonary involvement

Žůrková¹,

Kolek²,

Tománková³

et al. 2014

BIOMED PAP

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Introduction.Patients with pulmonary and pulmonary plus extrapulmonary sarcoidosis differ in symptom severity and health status impairment. To date there is no information on differences in clinical and laboratory parameters between these phenotypes and limited information on extrapulmonary involvement in Czech sarcoidosis patients exists. Methods. We therefore compared clinical data (age, gender, organ involvement, lung function tests) and laboratory data (blood counts, bronchoalveolar fluid (BAL) cellular profile, serum levels of CRP, SACE, sIL-2R, neopterin) between patients with newly diagnosed pulmonary sarcoidosis (n=107) and those with pulmonary plus extrapulmonary sarcoidosis (n=54). Results. Extrapulmonary sarcoidosis was diagnosed in 33% of patients, mostly affecting lymph nodes and skin and having hypercalciuria. There was no difference in the prevalence of extrapulmonary sarcoidosis between genders. Patients with extrapulmonary sarcoidosis were older and mostly non-smokers when compared to those with limited pulmonary form. X-ray Stage I and erythema nodosum were less frequent in extrapulmonary disease. Serum levels of CRP, SACE, sIL-2R and neopterin and BAL cellular profile did not differ between both phenotypes. We observed lower platelets, FEV1, VC, and BAL CD19+ in females with extrapulmonary involvement than in those with pulmonary disease. Conclusion. Affected lymph nodes, skin and hypercalciuria were the most common in sarcoidosis patients with extrapulmonary involvement. Pulmonary sarcoidosis did not differ in clinical and routine laboratory parameters from pulmonary plus extrapulmonary sarcoidosis. Observation of low platelets, VC, FEV1 and BAL CD19+ in females with extrapulmonary sarcoidosis needs further verification in larger cohort.

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Differences in symptom severity and health status impairment between patients with pulmonary and pulmonary plus extrapulmonary sarcoidosis

Cited by 61 publications

References 18 publications

Factors Associated With Fatigue in Sarcoidosis

Factors Associated With Fatigue in Sarcoidosis

A Concise Review of Pulmonary Sarcoidosis

Extrapulmonary involvement in patients with sarcoidosis and comparison of routine laboratory and clinical data to pulmonary involvement

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