Associations of lipoprotein subclasses and oxidative stress status in pulmonary and pulmonary plus extrapulmonary sarcoidosis.

Background: Sarcoidosis is an inflammatory disease with pulmonary and extrapulmonary manifestations. In such pathologic conditions, increased oxidative stress and rearrangement of high-density lipoprotein (HDL) and low-density lipoprotein (LDL) may occur. Objective: This study evaluated association of oxidative stress and lipoprotein subclasses in severe forms of pulmonary and pulmonary plus extrapulmonary sarcoidosis. Methods: Lipid parameters, LDL and HDL subclass distributions, high-sensitivity C-reactive protein (hsCRP), serum amyloid A (SAA), paraoxonase 1 (PON1), malondialdehyde (MDA), total-oxidant status (TOS), sulfhydryl (SH) groups, pro-oxidant anti-oxidant balance (PAB) were determined in 77 patients (53 isolated pulmonary and 24 pulmonary plus extrapulmonary) and 139 controls. Results: Both pulmonary and extrapulmonary sarcoidosis patients had significantly higher levels of triglycerides and TOS (P<0.05) and more LDL II, LDL III, LDL IVA particles (P<0.01), but lower HDL size, SH groups (P<0.001), PON1 activity and less LDL I subclasses (P<0.05) than controls. In isolated pulmonary disease, HDL-cholesterol (P<0.01) was significantly lower whereas proportions of HDL 3a and PAB were significantly higher (P<0.05) when compared with the control group. PON1 was significantly higher in pulmonary than in combined pulmonary-extrapulmonary disease (P<0.05). In pulmonary sarcoidosis, TOS and PON1 correlated significantly with small-sized HDL particles (P<0.05). Conclusions: Both patient groups were characterized by adverse lipoprotein profile and elevated oxidative stress. In isolated pulmonary group significant associations of oxidative stress and HDL particles distribution was demonstrated. Pulmonary sarcoidosis was associated with higher PON1 activity and rearrangement of LDL particles did not depend on disease localization. (Sarcoidosis Vasc Diffuse Lung Dis 2018; 35: 198-205).

Administering the Sarcoidosis Health Questionnaire to sarcoidosis patients in Serbia.

OBJECTIVE: The aim of this study was to use a Serbian-language version of the disease-specific, self-report Sarcoidosis Health Questionnaire (SHQ), which was designed and originally validated in the United States, to assess health status in sarcoidosis patients in Serbia, as well as validating the instrument for use in the country. METHODS: This was a cross-sectional study of 346 patients with biopsy-confirmed sarcoidosis. To evaluate the health status of the patients, we used the SHQ, which was translated into Serbian for the purposes of this study. We compared SHQ scores by patient gender and age, as well as by disease duration and treatment. Lower SHQ scores indicate poorer health status. RESULTS: The SHQ scores demonstrated differences in health status among subgroups of the sarcoidosis patients evaluated. Health status was found to be significantly poorer among female patients and older patients, as well as among those with chronic sarcoidosis or extrapulmonary manifestations of the disease. Monotherapy with methotrexate was found to be associated with better health status than was monotherapy with prednisone or combination therapy with prednisone and methotrexate. CONCLUSIONS: The SHQ is a reliable, disease-specific, self-report instrument. Although originally designed for use in the United States, the SHQ could be a useful tool for the assessment of health status in various non-English-speaking populations of sarcoidosis patients.

FDG PET/CT in bone sarcoidosis.

BACKGROUND: Bone sarcoidosis is rare manifestation of disease usually accompanied with pulmonary involvement. Until today, exact prevalence of bone sarcoidosis is not known, since reported prevalence varies widely depending on the studied population and the used diagnostic techniques. OBJECTIVE: To determine the prevalence of bone involvement and distribution pattern in active chronic sarcoidosis by using FDG PET/CT. METHODS: Between January 2010 and December 2011, 98 patients with chronic sarcoidosis and presence of prolonged symptoms or other findings suggestive of active disease were referred to FDG PET/CT examination. Active disease was found in 82 patients, and they all were screened for presence of bone sarcoidosis on FDG PET/CT. All patients also underwent MDCT and assessment of serum ACE level. RESULTS: Bone sarcoidosis was present in 18/82 patients with active sarcoidosis. FDG uptake in bones was focal in 8 (44.4%), diffuse in 6 (33.3%) and both diffuse and focal in 4 (22.2%) patients. CT indicated bone abnormalities only in 5% patients. Osseous involvement was present in: pelvis (61.1%), vertebrae (44.4%), ribs (27.8%) and bone marrow (16.7%). Some patients had two or more locations of disease. Follow-up FDG PET/CT showed normal findings in two patients, same localization of active disease in four patients and progression of disease in one. CONCLUSION: In patients with active chronic sarcoidosis 22% of patients had osseous abnormalities on FDG PET/CT that mostly were not detected on CT.

Association of serum amyloid A and oxidative stress with paraoxonase 1 in sarcoidosis patients.

BACKGROUND: It has been reported that high-density lipoprotein (HDL) particles have anti-inflammatory and antioxidant roles thanks to different enzymes such as paraoxonase 1 (PON1). Under inflammatory and oxidative stress conditions, HDL particles may lose their protective properties. Sarcoidosis is an inflammatory disease characterized by excessive oxidative stress. Serum amyloid A (SAA) is produced in liver and in granulomas, and its concentration increases in inflammatory conditions contributing to increased catabolism of HDL particles. The aim of our study was to determine PON1 activity, SAA concentration and their associations in patients with sarcoidosis. MATERIALS AND METHODS: Inflammatory [high-sensitive C-reactive protein (hsCRP), angiotensin-converting enzyme (ACE), SAA], lipid [total cholesterol (TC), HDL-cholesterol (HDL-c), low-density lipoprotein cholesterol (LDL-c), triglycerides (TG)] oxidative stress status parameters [total oxidant status (TOS), malondialdehyde (MDA), pro-oxidant-antioxidant balance (PAB), sulfhydryl (SH) groups] and PON1 activities were determined in serum of 72 patients with sarcoidosis and 62 healthy subjects. RESULTS: HsCRP (P < 0·05), TC, LDL-c, TG, SAA, TOS, MDA and PAB (P < 0·001) were significantly higher, whereas HDL-c, SH groups and PON1 activity (P < 0·001) were significantly lower in patients with sarcoidosis when compared with controls. PON1 showed significant association with SAA, MDA and PAB. It was shown that 71% of decrease in PON1 activity may be explained by increase in TOS, PAB and SAA concentration. CONCLUSIONS: We found decreased PON1 activity and increased SAA concentration in patients with sarcoidosis. Inflammatory condition presented by high SAA was implicated in impaired HDL functionality evident through dysregulated PON1 activity. Excessive oxidative stress was also involved in dysregulation of PON1 activity.

Verifying Sarcoidosis Activity: Chitotriosidase versus ACE in Sarcoidosis - a Case-control Study.

BACKGROUND: Until now, a proper biomarker(s) to evaluate sarcoidosis activity has not been recognized. The aims of this study were to evaluate the sensitivity and specificity of the two biomarkers of sarcoidosis activity already in use (serum angiotensin converting enzyme - ACE and serum chitotriosidase) in a population of 430 sarcoidosis patients. The activities of these markers were also analyzed in a group of 264 healthy controls. METHODS: Four hundred and thirty biopsy positive sarcoidosis patients were divided into groups with active and inactive disease, and groups with acute or chronic disease. In a subgroup of 55 sarcoidosis patients, activity was also assessed by F-18 fluorodeoxyglucose positron emission tomography (18F-FDG-PET) scanning. Both serum chitotriosidase and ACE levels showed non-normal distribution, so nonparametric tests were used in statistical analysis. RESULTS: Serum chitotriosidase activities were almost 6 times higher in patients with active sarcoidosis than in healthy controls and inactive disease. A serum chitotriosidase value of 100 nmol/mL/h had the sensitivity of .5% and specificity of 70.0%. A serum ACE activity cutoff value of 32.0 U/L had the sensitivity of 66.0% and the specificity of 54%. A statistically significant correlation was obtained between the focal granulomatous activity detected on 18F-FDG PET/CT and serum chitotriosidase levels, but no such correlation was found with ACE. The levels of serum chitotriosidase activity significantly correlated with the disease duration (P < 0.0001). Also, serum chitotriosidase significantly correlated with clinical outcome status (COS) categories (ρ =0.272, P =0.001). CONCLUSIONS: Serum chitotriosidase proved to be a reliable biomarker of sarcoidosis activity and disease chronicity.

Distribution of low-density lipoprotein and high-density lipoprotein subclasses in patients with sarcoidosis.

CONTEXT: Systemic inflammatory diseases are associated with proatherogenic lipoprotein profile, but there is a lack of information regarding overall distributions of lipoprotein subclasses in sarcoidosis. OBJECTIVE: To investigate whether patients with sarcoidosis have altered distributions of plasma low-density lipoprotein (LDL) and high-density lipoprotein (HDL) particles. DESIGN: Seventy-seven patients with biopsy-proven sarcoidosis (29 with acute and 48 with chronic sarcoidosis) treated with corticosteroids and 77 age- and sex-matched controls were included in the study. Low-density lipoprotein and HDL subclasses were determined by gradient gel electrophoresis, while inflammatory markers and lipid parameters were measured by standard laboratory methods. RESULTS: Compared to controls, patients had fewer LDL I subclasses (P < .001), but more LDL II and III (P < .001) subclasses. This pattern was evident in both acute and chronic disease groups. Patients also had smaller HDL size (P < .001) and higher proportions of HDL 2a (P = .006) and 3a particles (P = .004). Patients with chronic sarcoidosis had smaller LDL size than those with acute disease (P = .02) and higher proportions of HDL 3a subclasses (P = .04) than controls. In acute sarcoidosis, relative proportions of LDL and HDL particles were associated with levels of inflammatory markers, whereas in chronic disease an association with concentrations of serum lipid parameters was found. CONCLUSIONS: The obtained results demonstrate adverse lipoprotein subfraction profile in sarcoidosis with sustained alterations during disease course. Evaluation of LDL and HDL particles may be helpful in identifying patients with higher cardiovascular risk, at least for prolonged corticosteroid therapy due to chronic disease course.

Tumor necrosis factor alpha gene polymorphism in serbian patients with sarcoidosis.

INTRODUCTION: Sarcoidosis is a multisystemic disease of unknown etiology. Genetic factors play a considerable role in the onset of the disease. Tumor necrosis factor alpha (TNF-a) is a proinflammatory cytokine which plays an important role in the pathogenesis of the disease and the formation of granuloma by regulating cellular proliferation and apoptosis. OBJECTIVE: The aim of this study was to investigate the role of TNF-alpha-308 G/A polymorphism in the development of sarcoidosis and to evaluate the association between the aforementioned type of polymorphism and the clinical course of the disease. METHODS: Seventy patients with sarcoidosis and 50 healthy volunteers were genotyped for the TNF-alpha-308G/A polymorphism. Polymorphism variants were examined by PCR-RFLP (polymerase chain reaction-restriction fragment length polymorphism) on the DNA isolated from blood leukocytes. RESULTS: There were no significant differences in TNF-alpha-308A allele frequency distribution between sarcoidosis patients and the control group, but the TNF-alpha-308A allele was observed significantly more frequently in the sarcoidosis patients with Löfgren's syndrome when compared with non-Löfgren's patients. CONCLUSION: We have found that the TNF-alpha-308A variant is associated with Löfgren's syndrome in Serbian patients with sarcoidosis.

Responsiveness of FDG PET/CT to treatment of patients with active chronic sarcoidosis.

PURPOSE: This study aimed to compare baseline to follow-up 18F-FDG PET/CT findings after treatment for active chronic sarcoidosis and to correlate changes on 18F-FDG PET/CT with changes in clinical status. PATIENTS AND METHODS: The sample included 66 patients with chronic sarcoidosis and evidence of active inflammation on baseline F-FDG PET/CT for which they received therapy. Of these 66 patients, 30 returned for the follow-up 18F-FDG PET/CT after 12 (5) months to evaluate response to treatment. They were also asked to indicate changes in clinical status. Baseline characteristics of patients who did and did not return for the follow-up were compared to assess selection bias. RESULTS: SUVmax was significantly decreased at the follow-up compared with baseline 18F-FDG PET/CT (8.46 [3.52] vs 4.90 [0.96]; P = 0.006), primarily in the mediastinum. Inflammatory activity appeared absent in 9 patients, decreased in 12 patients, and increased in 9 patients, with the corresponding changes in SUVmax of -80%, -41%, and +54%, respectively. The changes on 18F-FDG PET/CT were in agreement with self-perceived changes in clinical symptoms (P = 0.019). The angiotensin-converting enzyme at the follow-up was not significantly different from baseline (49.80 [19.25] vs 46.35 [25.58], P = 0.522). There was no difference in baseline characteristics of patients who did and did not return for the follow-up. CONCLUSIONS: 18F-FDG PET/CT is able to detect clinically meaningful changes in magnitude and extent of inflammatory activity in patients receiving treatment for active chronic sarcoidosis. Thus, 18F-FDG PET/CT is a valuable adjunct to clinical evaluation for monitoring the response to treatment in these patients.

The utility of 18F-FDG PET/CT for diagnosis and adjustment of therapy in patients with active chronic sarcoidosis.

UNLABELLED: The purpose of this study was to assess the utility of (18)F-FDG PET/CT for detection of inflammation in granulomatous sites and management of patients with chronic sarcoidosis. The 3 specific aims were to assess differences between (18)F-FDG PET/CT and multidetector CT (MDCT) findings, to compare (18)F-FDG PET/CT results with serum levels of angiotensin-converting enzyme (ACE), and to determine whether (18)F-FDG PET/CT findings are associated with the decision to change therapy. METHODS: We studied 90 sarcoidosis patients (mean age ± SD, 47 ± 12 y; 32 men and 58 women) with persistent symptoms who were referred for (18)F-FDG PET/CT evaluation to assess the extent of inflammation. They also underwent MDCT and measurement of serum ACE level. After the follow-up (12 ± 5 mo after (18)F-FDG PET/CT), the clinical status and changes in therapy were analyzed. RESULTS: (18)F-FDG PET/CT detected inflammation in 74 patients (82%) (maximum standardized uptake value, 8.1 ± 3.9). MDCT was positive for sarcoidosis in 6 additional patients (80, 89%). The difference between the 2 methods was not significant (P = 0.238, McNemar test), and their agreement was fair (κ = 0.198). Although ACE levels were significantly higher in patients with positive than negative (18)F-FDG PET/CT results (P = 0.002, Mann-Whitney test), 38 patients (51%) with positive (18)F-FDG PET/CT results had normal ACE levels. The therapy was initiated or changed in 73 out of 90 patients (81%). Both univariate and multivariate logistic regression analyses indicated that positive (18)F-FDG PET/CT results were significantly (P < 0.001) associated with changes in therapy, with no contribution from age, sex, ACE level, CT results, or previous therapy. CONCLUSION: Our results indicate that (18)F-FDG PET/CT is a useful adjunct to other diagnostic methods for detecting active inflammatory sites in chronic sarcoidosis patients with persistent symptoms, especially those with normal ACE levels. (18)F-FDG PET/CT proved advantageous for determining the spread of active disease throughout the body and influenced the decision to adjust the therapy.

Fatigue in sarcoidosis: detection and treatment.

Fatigue is a prominent symptom in a large number of medical conditions, malignant and infectious diseases. Fatigue is also a prominent symptom of sarcoidosis. The occurrence of fatigue in sarcoidosis is well known but exact incidence has not been established and varies from 30-70% of patients depending on age, sex and organ involvement by the granulomatous process. The exact definition of fatigue varies broadly. It can be both physical and mental. The patients describe their sensation of fatigue qualitatively different from that fatigue they experienced before they became sick. Fatigue has a major impact on the quality of life in sarcoidosis. Establishing the extent of fatigue in sarcoidosis provides relevant insight regarding the patient's quality of life. Unfortunately there is no objective parameter for assessing fatigue in sarcoidosis. Generally, fatigue is detected by means of questionnaires. Regarding the therapy, there is no effective treatment for fatigue in sarcoidosis.

Dyslipidemia and oxidative stress in sarcoidosis patients.

OBJECTIVES: Sarcoidosis is an inflammatory disease characterised by enhanced production of reactive oxygen species and alterations in the circulating lipid profile. Both attributes are thought to play a role in its pathogenesis. However, current knowledge regarding the significance of blood oxidative stress/anti-oxidant defence as well as alterations in lipid status parameters in sarcoidosis is scarce. The aim of our study was to assess these parameters and their inter-relationships, as well as their potential for patient-control discrimination. DESIGN AND METHODS: Oxidative stress status and anti-oxidant defence parameters were determined in serum and erythrocytes and lipid status parameters were assessed in the serum of 213 treated sarcoidosis patients and 90 controls. RESULTS: Malondialdehyde, superoxide anion, total oxidant status, prooxidant-antioxidant balance and triglycerides were significantly higher whereas total anti-oxidant status, superoxide dismutase activity and HDL-cholesterol were significantly lower in sarcoidosis patients compared with controls. Total sulfhydryl group content was higher in patients compared with controls. Serum and erythrocyte malondialdehyde exhibited the strongest ability to predict disease presence. Elevated oxidative stress was characterised by higher clinical accuracy compared with lipid status abnormality. Some oxidative stress and lipid status markers were significantly associated in sarcoidosis. CONCLUSIONS: Sarcoidosis is characterised by increased oxidative stress, diminished overall anti-oxidative protection and alterations in the circulating lipid profile. Both oxidative stress and lipid status parameters demonstrated the potential to discriminate sarcoidosis from controls which was particularly evident from the point of view of oxidative stress status parameters. Association between these parameters may indicate an increased risk for atherosclerosis development.

[The impact of resistant strains of Mycobacterium tuberculosis on relapse of tuberculosis].

INTRODUCTION: Relapses of tuberculosis are fairly rare nowdays and they represent the onset of tuberculosis two, or more than two years after completion of previous treatment. MATERIAL AND METHODS: In the previous period, relapses of tuberculosis occurred in 141 patients (87 male and 54 female). Their mean age was 46.2 years. RESULTS: Relapses of tuberculosis occurred after 11.3 years, on average. All patients presented with pulmonary tuberculosis, and two patients also had pulmonary and extrapulmonary tuberculosis (bones). Resistance was one of the statistically significant factors for relapse of tuberculosis. Resistance to one antituberculotic agent was most common--8 patients, resistance to two drugs--4 patients, resistance to three drugs--4 patients, resistance to four drugs in 5 patients. Due to these findings on resistant strains of mycobacterium tuberculosis, a huge number of patients with relapses of tuberculosis had full recovery and completed the treatment. CONCLUSION: The importance of resistant strains of mycobacterium tuberculosis is really huge in our conditions. The findings of these resistant strains of mycobacterium tuberculosis and adequate medical treatment are obligatory nowadays.

[The importance of hypercalciuria in assessing the clinical course and treatment modalities of sarcoidosis].

INTRODUCTION: In patients with sarcoidosis high levels of Ca2+ in blood serum accompanied by increased 24-hour urinary calcium are of great diagnostic and prognostic value. High levels of these two important parameters may point to hyperparathyroidism and/or chronic sarcoidosis. It is necessary to exclude kidney insufficiency by kidney ultrasound. MATERIAL AND METHODS: During the previous four years (1999-2003), urinary Ca was significantly higher than the physiological level in 25 patients, whereas the blood serun Ca was normal. 18 patients received corticosteroid therapy (40 mg for two months, and 35 mg later on). Patients with acute sarcoidosis received prednisone for 11.8 months, while patients with chronic sarcoidosis received it for 13.6 months. One patient with chronic sarcoidosis received methotrexate, as alternative therapy. RESULTS: 4 months later, after normalization of urinary Ca excretion, the follow-up of patients revealed only one patient with increased urinary Ca excretion associated with increased ACE and radiographic progression of the disease.

[Chronic sarcoidosis].

INTRODUCTION: According to available literature data, chronic pulmonary and extrapulmonary sarcoidosis occurs in 10-30% of all sarcoidosis patients. Unpredictable course of the disease is a great challenge for scientists and researchers. Clinical and biological parameters for evaluation and prediction of the course of the disease are still the topic of different scientific investigations all over the world. According to an American case control study on sarcoidosis, unique diagnostic criteria have been established in order to simplify the diagnosis of sarcoidosis. The aim of this study was to present the morbidity and the clinical course of sarcoidosis in our patients. MATERIALS AND METHODS: We analyzed 370 sarcoidosis patients and confirmed the diagnosis of sarcoidosis by biopsy of the suspected granuloma, and by excluding any other possible cause of granulomatous inflammation. In our analyzed patients with sarcoidosis, chronic form was diagnosed in about 30%. An extremly unpredictable, chronic form of the disease was established in patients with extrapulmonary localisations (heart, CNS, liver and bones). CONCLUSION: Follow-up criteria and control examinations of sarcoidosis patients are suggested as well.

[Quality-of-life assessment in patients with pulmonary diseases].

INTRODUCTION: Quality-of-life assessment as a measure of clinical and therapeutic outcome, is increasingly used in different branches of medicine. In contrast to conventional indicators of the disease and its objective outcomes, health related quality of life (HRQL) focuses on the patient's own assessment. This provides for the more active involvement of a patient, where the advantages of certain medication or therapeutic regimes over another are considered by a doctor. QUALITY-OF-LIFE QUESTIONNAIRES: Quality-of-life questionnaires have been developed to assess health related quality of life, and provide methodology for processing and interpretation. This kind of assessment is proved useful not only in clinical drug trials, but also efficacy in routine medical practice and in the evaluation of the health services. Quality-of-life assessment is widely used in all chronic pulmonary diseases, especially in asthma and chronic obstructive pulmonary diseases. Sarcoidosis is a great challenge for researchers in quality of life, since it is a chronic multisystem disease, not only a respiratory disorder. CONCLUSION: Evaluation of quality of life in sarcoidosis patients is possible only using generic health questionnaires. However, in 2003, validated disease-specific questionnaires for sarcoidosis were developed, and they will make our approach to these patients easier.

[Application of measuring instruments--quality of life questionnaires in patients with chronic sarcoidosis].

INTRODUCTION: Health-related quality of life in interstitial lung diseases, especially in sarcoidosis, has hardly received appropriate attention in clinical studies due to lack of validated methods of measurement. Until now, in patients with sarcoidosis and interstitial lung diseases, several generic and respiratory specific quality-of-life instruments were used in order to discover the most valid and reliable quality-of-life instrument. Sarcoidosis is a multi-system disease that affects quality of life in many different ways. MATERIAL AND METHODS: In this study the Sarcoidosis Health Questionnaire was used to evaluate the quality of life in sarcoidosis patients. 89 biopsy positive sarcoidosis patients were analyzed (16 male, 73 female); their mean age 46.15 +/- 11.11 years. 34 (39%) patients presented with acute sarcoidosis, 53 (61%) with chronic sarcoidosis and 46 patients (51.7%) had extrapulmonary disease. In regard to treatment, 51 (57%) patients were treated with corticosteroids 18 (20%) with methotrexate and in 20 (23%) spontaneous remission was reported. All analyses were performed using the Statistical Package for Social Science Software: A probability value less than 0.01 considered being statistically significant. RESULTS: Statistically significant correlation was found between the sarcoidosis health questionnaire scores and chronic sarcoidosis. daily 0.001, emotional 0.014 and total 0.01. In regard to treatment, significant difference between groups was found in the domain of physical (sig 0.006) emotional (sign 0.005) and total (sign 0.001) scores. CONCLUSION: The first sarcoidosis specific questionnaire shows perfect correlation with the possible clinical course in patients with sarcoidosis.

[The role of EQ5D self-classifier in assessing quality of life in patients with sarcoidosis].

INTRODUCTION: In medicine, quality of life is a very important issue. Nowdays, in our circumstances, it is an important part of diagnostic and therapeutic procedures. The aim of this study was to analyze the role of EQ5D questionnaire in patients with sarcoidosis. MATERIAL AND METHODS: EQ5D self-questionnaire was used in patients with sarcoidosis and we analyzed the obtained data. RESULTS: The analysis included patients with previously proved sarcoidosis--pulnmonary and extrapulmonary (bronchoscopy and other biopsies). All patients were treated at the Institute of Tuberculosis and Lung Diseases. We analyzed a group of 84 (19 male and 65 female) patients with average age of 45 years. Most patients had a chronic state of disease and were nonsmokers. In regard to the radiographic stage of pulmonary sarcoidosis, levels of disease activity (acute, chronic and relapse), levels of sACE, levels of sIgE, smokers--non smokers, and in regard to obtained scores, no statistically significant difference was found in examined groups, except in the group of patients with low level sIgE (score 0.276). CONCLUSION: EQ5D questionnaire is a good tool for analyzing the health status of patients with sarcoidosis, but still a more specific questionnaire should be designed for this multisystem disease.

[St. George's respiratory questionnaire (SGRQ) in sarcoidosis patients].

INTRODUCTION: Sarcoidosis is a chronic multisystem disorder which has a great impact on health-related quality of life (HRQL). Patients with sarcoidosis very often present with bronchial obstruction. The purpose of this study was to assess the impact of respiratory disorder on general HRQL using St. George's respiratory questionnaire (SGRQ). MATERIAL AND METHODS: We examined 129 patients with histologically proven sarcoidosis. All patients underwent clinical examination, chest X-ray and spirometry, and in all skin prick tests and sera ACE and IgE were determined. Afterwards, they filled out SGRQ, and scores were compared with clinical and radiological findings, and also with serum markers of the disease. RESULTS: Mean activity score values were significantly lower in men, in patients with newly diagnosed disease, and in patients with elevated ACE. Patients with extrathoracic disease had significantly higher scores. Clinical course showed significant correlation with impact and total score, and the number of relapses with the activity score. SGRQ scores significantly correlated with serum IgE and with most spirometric parameters. CONCLUSION: Our data revealed a high validity of SGRQ in patients with sarcoidosis and a great influence of respiratory disorders on general health-related quality of life in these patients. However, reproducibility and responsiveness of SGRQ is yet to be established in patients with sarcoidosis.

New observations on pulmonary function changes in sarcoidosis.

Respiratory tract involvement occurs at some time during the course of most patients with sarcoidosis. There are many articles on lung function impairment in sarcoidosis, but the definite, unique guideline considering the correlation between the clinical, radiologic, and biochemical findings of the disease is lacking. During the last few years, most of the literature has focused on follow-up studies, presenting primarily the effects of the treatment on lung function impairment in patients with sarcoidosis. This study focuses on airflow impairment, diffusion impairment, and bronchial hyperresponsiveness in sarcoidosis. The topic has already been explored, but this time the authors emphasize lung function impairment and its correlation with the course of the disease. Considering the course of sarcoidosis, a significantly higher number of patients with diffusion impairment have the chronic form of the disease. The bronchial challenge test (BCT) was performed in patients with chronic sarcoidosis at the time they experienced relapse of disease activity. A high number of patients with positive BCT is significant in light of their disease. Further analyses, not only functional, but immunologic, are necessary to examine the potential correlation between positive BCT and the activity of sarcoidosis.