The Short- and Long-Term Impact of Pulmonary Rehabilitation in Subjects with Sarcoidosis: A Prospective Study and Review of the Literature.

BACKGROUND: Sarcoidosis is a heterogeneous multisystemic disorder of unknown etiology. Dyspnea and fatigue are two of the most common and debilitating symptoms experienced by subjects with sarcoidosis. There is limited evidence regarding the short- and long-term impact of pulmonary rehabilitation (PR) on exercise capacity and fatigue in these individuals. OBJECTIVE: To evaluate the benefit of PR in subjects with pulmonary sarcoidosis at different severity stages and to review the current literature about PR in sarcoidosis. METHODS: PR included a 12-week training program of a twice-weekly 90-min workouts. Fifty-two subjects with stable pulmonary sarcoidosis were recruited. Maximal exercise capacity, defined as VO2max, was measured using the cardiopulmonary exercise test (CPET). Pulmonary function tests, 6-min walking distance (6MWD), St. George's Respiratory Questionnaire (SGRQ), and the modified Medical Research Council (mMRC) and Hospital Anxiety and Depression Scale (HADS) questionnaires were given before and after PR and following 6 months (follow-up). RESULTS: The PR program significantly increased the VO2max (1.8 ± 2.3 mL/kg/min, p = 0.002), following 12 weeks. mMRC and SGRQ scores were also improved (-0.3 ± 0.8, p = 0.03, and -3.87 ± 10.4, p = 0.03, respectively). The impact of PR on VO2max was more pronounced in subjects with pulmonary parenchymal involvement. The increase in VO2max correlated with initial disease severity (indicated by FEV1/FVC, p = 0.01). Subjects with FEV1/FVC <70% showed greater improvement in 6MWD. 6MWD also improved in those with a transfer coefficient of the lung for CO (KCO) above 80% predicted (p < 0.05). At 6-month follow-up, the VO2max, 6MWD, and SGRQ scores remained stable, thus suggesting lasting effects of PR. CONCLUSION: PR is a promising complementary therapeutic intervention for subjects with sarcoidosis. Further study is needed to validate these findings.

[Rehabilitation of patients with sarcoidosis]. / Rehabilitacja chorych na sarkoidoze.

Comprehensive rehabilitation programs have so far been developed for many chronic diseases. It has been proven that their use can be safe and effective in lung diseases such as chronic obstructive pulmonary disease. There are still no standards of rehabilitation in the group of patients with sarcoidosis available. This situation results mainly from a small number of large, randomized studies concerning this topic. The available literature, however, allows defining some general rules in this field. It also provides evidence for the effectiveness of rehabilitation in reducing symptoms, improving the quality of life and prognosis in patients with sarcoidosis. Interventions such as endurance and strength training, including inspiratory muscle training, have been applied. Further research is necessary to confirm these data.

Efficacy of a Structured Exercise Program for Improving Functional Capacity and Quality of Life in Patients With Stage 3 and 4 Sarcoidosis: A RANDOMIZED CONTROLLED TRIAL.

PURPOSE: This study investigated the effects of an exercise program on functional capacity and quality of life in patients with stage 3 and stage 4 sarcoidosis. METHODS: Eighteen patients with stage 3 and 4 sarcoidosis were recruited; 9 received 12 wk of supervised exercise training and 9 received usual care. Patients underwent the following evaluations at baseline and follow-up: 6-min walk test, maximal inspiratory and expiratory pressure tests, back and leg dynamometer test, modified Medical Research Council Dyspnea Scale, Fatigue Severity Scale, St George Respiratory Questionnaire, Short Form-36 Quality of Life Questionnaire, Hospital Anxiety and Depression Questionnaire, body plethysmography, carbon monoxide diffusing capacity test, and blood gas analysis. RESULTS: The median (interquartile range) increase in 6-min walk distance in the intervention group was 40 (31-62) m. Improvement in functional capacity; perception of dyspnea; fatigue; anxiety; peripheral and inspiratory muscle strength; partial arterial oxygen pressure; arterial oxygen saturation; and the symptom, activity, and total scores of the St George Respiratory Questionnaire were significantly greater in the intervention group than in the usual care group at follow-up (P < .05). CONCLUSIONS: Exercise training improves functional capacity, muscle strength, dyspnea, quality of life, anxiety, fatigue, and oxygenation in patients with stage 3 and stage 4 sarcoidosis. Standard treatment of patients with late-stage sarcoidosis should integrate exercise training and pulmonary rehabilitation.

Physical activity and training in sarcoidosis: review and experience-based recommendations.

INTRODUCTION: Sarcoidosis is a multisystemic inflammatory disorder with a great variety of symptoms, including fatigue, dyspnea, pain, reduced exercise tolerance and muscle strength. Physical training has the potential to improve exercise capacity and muscle strength, and reduce fatigue. The aim of this review and survey was to present information about the role of physical training in sarcoidosis and offer practical guidelines. AREAS COVERED: A systematic literature review guided an international consensus effort among sarcoidosis experts to establish practice-basic recommendations for the implementation of exercise as treatment for patients with various manifestations of sarcoidosis. International sarcoidosis experts suggested considering physical training in symptomatic patients with sarcoidosis. Expert commentary: There is promising evidence of a positive effect of physical training. Recommendations were based on available data and expert consensus. However, the heterogeneity of these patients will require modification and program adjustment of the standard rehabilitation format for e.g. COPD or interstitial lung diseases. An optimal training program (types of exercise, intensities, frequency, duration) still needs to be defined to optimize training adjustments, especially reduction of fatigue. Further randomized controlled trials are needed to consolidate these findings and optimize the comprehensive care of sarcoidosis patients.

Benefits of Physical Training in Sarcoidosis.

BACKGROUND: Sarcoidosis patients suffer from fatigue and exercise limitation. The aim of this study was to establish whether a physical training program improves these and other outcomes important to sarcoidosis patients. METHODS: From 11/2012 to 9/2014, 201 sarcoidosis patients were referred to the ild care expertise team, Ede, the Netherlands. In our center, all patients are routinely recommended to undergo testing at baseline to determine their physical functioning and encouraged to complete a 12-week, supervised physical training program. Ninety patients underwent baseline testing and returned for repeat testing at 3 months in the interim, 49 completed the training program (Group I) and 41 chose not to participate (Group II). Change over time (from baseline to 3 months) in fatigue, exercise capacity, and skeletal muscle strength were assessed between the two groups. RESULTS: At baseline, there were no between-group differences for fatigue, DLCO%, FVC%, or exercise capacity [assessed by percent predicted six-minute walk distance (6MWD%) and Steep Ramp Test (SRT)]. The 6MWD for Group I improved between baseline and 3 months, while the 6MWD remained the same in Group II (F = 72.2, p < 0.001). Group I showed a significantly larger decrease of fatigue compared with Group II (F = 6.27, p = 0.014). Lung function tests did not change in either group. CONCLUSION: A supervised physical training program improves exercise capacity and fatigue among sarcoidosis patients and should be included in their management regimen.

Presumed intramedullary spinal cord sarcoidosis in a healthy young adult woman.

Sarcoidosis is an inflammatory disease of unknown etiology associated with the development of granulomatous nodules in various organs, most commonly the lungs, eyes, and skin. It rarely affects the central nervous system, with the spinal cord being least common area of involvement. However, when sarcoidosis does affect the central nervous system, it is often the first presentation of the disease, making diagnosis more difficult. Physical examination findings are consistent with spinal cord pathology, and imaging often suggests spinal cord tumor. We present a case of an otherwise healthy young woman with a granulomatous mass in her cervico-thoracic spinal cord presumed to be sarcoid and review the clinical findings, diagnosis, treatment, and prognosis associated with this rare disease.

Manifestaciones cutáneas de la sarcoidosis / No disponible

Aunque las manifestaciones cutáneas de la sarcoidosis, las agudas, pueden presentar remisiones, las crónicas pueden ser persistentes, y ser motivo importante de consulta. En nuestra serie de 110 pacientes, 25 presentaron afección cutánea (22,52%), de estos 20 tenían lesiones dérmicas específicas (18,2%) y 5 (4,5%) lesiones inespecíficas. Las lesiones específicas que predominaron fueron las erupciones maculopapulares y las placas y todas presentaron relaciones con estadios radiográficos de esta entidad, fundamentalmente en el estadio I y II. La presencia de afectación clínica fue más representativa en forma de erupciones maculopapulares y en placas, al igual que la evolución crónica. El estudio histopatológico, que según el órgano afectado ayudará al diagnóstico, y la piel por su accesibilidad y su especificidad con la demostración de granulomas sarcoideos, orienta a su confirmación y evita otros exámenes más agresivos y más costosos

Although acute cutaneous manifestations of sarcoidosis may present recurrences, those chronic may persist and be important causes of patient remission to health clinics and dermatologists. In our serie of 110 patients, 25 presented cutaneous affection (22,52 %), 20 out of them had specific skin lesions (18,2%) and 5 (4,5%) non specific lesions. The specific lesions that prevailed were maculopapular eruptions and plates, and all had relationships with radiographic studies of this entity, mainly in I and II stages. The persistence of affections were more representative in maculopapular eruptions and disease, biopsy with the histopathology study which depends of the affected organ, will help to the diagnosis; and the skin due to its accessibility and specificity with the demonstration in sarcoid granulomas guides to its confirmation and prevent more aggressive and expensive exams

[Experience in organizing ambulatory control of patients with sarcoidosis in Moscow]. / Opyt organizatsii dispansernogo nabliudeniia bol'nykh sarkoidozom v Moskve.

Dispensary record group VIII for patients with sarcoidosis was introduced in Moscow in 1994 and a center based on the Moscow Research Production Center?? was set up to diagnose and treat such patients. In addition to advisory work, the sarcoidosis center performs organizational and methodological functions. A scheme of subgroup (A, B, and C) distribution of Group III patients by the activity and pattern of sarcoidosis has been developed to have unique follow-up methods. The diagnosis made in the patients and their dispensary registration, the efficiency of treatment, and their movement by subgroups are checked up. This system of a center-dispensary interaction revealed a dynamics in sarcoidosis incidence and prevalence in the city in 1994-1997. Evidence is provided for that it is expedient and timely to organize a follow-up of patients with sarcoidosis particularly when the share of paid medical services is increasing.

Progressive neurosarcoidosis: a case report.

Neurosarcoidosis affects 3% to 5% of patients with sarcoidosis. It involves primarily the central nervous system and/or the peripheral nervous system. The treatment of a patient with neurosarcoidosis is difficult, and functional improvement following intensive rehabilitation has not been described. We report a middle-aged man who presented initially with ophthalmologic and pulmonary symptoms consistent with sarcoidosis and who later developed progressive weakness of the lower extremities, with impaired ambulation. The patient's clinical presentation, assessment, and rehabilitation management are presented. Also, the different pharmacologic treatments used to control the disease, and that may alter the long-term functional improvement of patients with neurosarcoidosis, are discussed.