Head and neck sarcoidosis, from wait and see to tumor necrosis factor alpha therapy: A pilot study

Knopf, Andreas; Lahmer, Tobias; Chaker, Adam; Stark, Thomas; Hofauer, Benedikt; Pickhard, Anja; Thürmel, Klaus; Baş, Murat

doi:10.1002/hed.23022

Cited by 17 publications

(10 citation statements)

References 22 publications

(26 reference statements)

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“…Severe SS-A/B-positive systemic disease is underrepresented [11,12]. Second, the control population includes sSS and sarcoidosis patients who also demonstrated changes in glandular morphology and function [6,31]. Third, UWS and Schirmer tests lack sufficient sensitivity and specificity to identify early disease stages, which are overrepresented in the current study.…”

Section: Discussionmentioning

confidence: 95%

Diagnostic utility of Acoustic Radiation Force Impulse (ARFI) imaging in primary Sjoegren`s syndrome

et al. 2015

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Section: Discussionmentioning

confidence: 95%

Diagnostic utility of Acoustic Radiation Force Impulse (ARFI) imaging in primary Sjoegren`s syndrome

et al. 2015

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“…Sarcoidosis is a multisystem inflammatory disorder of unknown etiology characterized by noncaseating granulomas composed of epithelioid giant cells, macrophages, and lymphocytes [24,25] . Sarcoidosis predominantly affects young adults and an incidence of 10-12 per 100,000 persons is estimated [26] .…”

Section: Sarcoidosismentioning

confidence: 99%

“…The combination of parotid gland involvement with fever, uveitis, and often unilateral palsy of the facial nerve is called Heerfordt syndrome. Behind cervical lymphadenopathy, the parotid gland is the second most affected organ in patients with sarcoidosis of the head and neck [24] .…”

Section: Sarcoidosismentioning

confidence: 99%

Biomarkers in Autoimmune Salivary Gland Disorders: A Review

Hofauer

Thuermel

Gahleitner

et al. 2017

ORL

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Salivary glands are frequent sites of manifestations of autoimmune disorders in the head and neck. Sjögren syndrome, sarcoidosis, granulomatosis with polyangiitis, and IgG4-related sialadenitis represent the most important autoimmune salivary gland disorders. Due to the lack of specific symptoms, diagnosis of these conditions remains a challenge. Diagnosis is usually based on classification criteria involving clinical tests, histopathological evaluation, and serological examinations. Depending on the disease, biomarkers are of different value and have to be interpreted carefully. In Sjögren syndrome, antibodies against Ro/SS-A and La/SS-B are essential and part of established classification criteria. In sarcoidosis, biomarkers such as angiotensin-converting enzyme, serum amyloid A, adenosine deaminase, and soluble interleukin-2 receptor are not suitable to confirm a diagnosis due to low sensitivity and specificity, but allow a differentiation between active and inactive disease. In patients with suspected granulomatosis with polyangiitis, positivity for anti-neutrophil cytoplasmic antibodies (ANCA) allows a diagnosis without histopathological confirmation in selected cases. In the head and neck, limited manifestations are common, in which less patients are positive for ANCA and histopathological confirmation is required. Diagnosis of IgG4-related sialadenitis solely based on elevated IgG4 serum levels is not possible. The concentration of blood plasmablasts is reported to have a higher diagnostic value.

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“…A pilot study comparing observation, pulse corticosteroids, stable dose corticosteroids, or TNF-a antagonist adalimumab therapy, was conducted in 31 patients, 21 having isolated head and neck manifestations [31]. It was suggested that pulse therapy was the most effective treatment option, preventing the associated complications of continuous systemic steroids.…”

Section: Treatmentmentioning

confidence: 99%

“…It was suggested that pulse therapy was the most effective treatment option, preventing the associated complications of continuous systemic steroids. This study provided a major recommendation for management of head and neck sarcoidosis, an important step without precedent in literature [31].…”

Section: Treatmentmentioning

confidence: 99%

Sarcoidosis of the Head and Neck

Badhey

Kadakia

Carrau

et al. 2014

Head and Neck Pathol

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Sarcoidosis is a complex disorder that often times involves the head and neck. Despite the presence of strong clinical evidence, tissue diagnosis and imaging is needed for confirmation of the disease. Although typically managed medically, when found in the sinonasal tract or intracranially, it may necessitate the intervention of a rhinologist-skull base surgeon. This article seeks to provide a comprehensive review of head and neck sarcoidosis, as this fascinating disorder often poses a diagnostic and therapeutic challenge. A brief discussion of surgical treatment for pituitary lesions is also provided. Articles from 1997 to 2013 were selected and reviewed by three researchers utilizing the most recent literature regarding sarcoidosis in the head and neck. PubMed searches were conducted using search terms such as "sarcoidosis", "neurosarcoid", and "extra-pulmonary sarcoid", among many others. A large collection of articles was generated and reviewed by the team of authors, and appropriate information was extracted to compose a thorough and expansive review of the subject. 10-15 % of patients with sarcoidosis have head and neck manifestations. Sinonasal and pituitary sarcoidosis presents a diagnostic challenge owing to its non-specific symptoms. Although systemic steroid therapy is often the first time treatment, endoscopic surgery is commonly used to treat advanced pituitary sarcoidosis refractory to medical management. As tissue diagnosis and imaging is key, a multi-disciplinary team approach is advantageous. Our study collates the available literature on head and neck sarcoidosis to provide a comprehensive review of the subject. This provides helpful information to guide all practitioners involved in the care of these challenging patients, namely pathologists, radiologists, otolaryngologists, and skull base surgeons, in the workup and management of head and neck sarcoidosis.

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Head and neck sarcoidosis, from wait and see to tumor necrosis factor alpha therapy: A pilot study

Abstract: Most patients with head and neck sarcoidosis did not require systemic therapy. We suggest corticosteroid-pulse therapy for patients with severe head and neck manifestation. Adalimumab might be potent for nonresponder.

Cited by 17 publications

References 22 publications

Diagnostic utility of Acoustic Radiation Force Impulse (ARFI) imaging in primary Sjoegren`s syndrome

Diagnostic utility of Acoustic Radiation Force Impulse (ARFI) imaging in primary Sjoegren`s syndrome

Biomarkers in Autoimmune Salivary Gland Disorders: A Review

Sarcoidosis of the Head and Neck

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