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1.
An Bras Dermatol ; 95(1): 57-62, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31889592

RESUMO

BACKGROUND: Sarcoidosis is a multisystem disease of unknown cause that is characterized by the presence of granulomas in various organs. Cutaneous involvement is common and the reported incidence has varied from 9% to 37%. Studies on cutaneous sarcoidosis in Brazil are lacking. OBJECTIVES: To describe the clinical and epidemiological aspects of patients with cutaneous sarcoidosis diagnosed at the Department of Dermatology of the University of São Paulo, from May 1994 to March 2018. METHODS: Clinical data of patients with confirmed cutaneous sarcoidosis were retrospectively reviewed and classified according to gender, ethnicity, age at diagnosis, cutaneous presentation, systemic involvement and treatment. RESULTS: Cutaneous sarcoidosis was diagnosed in 72 patients with a female predominance (74%). The mean age at diagnosis was 49.6 years and most of the patients were white (61%). Papules and plaques were the most common lesions. Systemic sarcoidosis was detected in 81% of patients, affecting mainly the lungs and thoracic lymph nodes (97%). Typically, cutaneous lesions were the first manifestation (74%). Systemic therapy was necessary for 72% of patients; the dermatologist managed many of these cases. Oral glucocorticoids were the most commonly used systemic medication (92%). The mean number of systemic drugs used was 1.98 per patient. LIMITATIONS: Insufficient data in medical records. CONCLUSIONS: This series highlights the dermatologist role in recognizing and diagnosing cutaneous sarcoidosis, evaluating patients for systemic disease involvement and treating the skin manifestations. Cutaneous sarcoidosis was once considered exceedingly infrequent in Brazil in comparison to infectious granulomatous diseases; however, the present series seems to suggest that the disease is not so rare in this region.


Assuntos
Sarcoidose/epidemiologia , Dermatopatias/epidemiologia , Centros de Atenção Terciária/estatística & dados numéricos , Administração Cutânea , Adulto , Idoso , Brasil/epidemiologia , Fármacos Dermatológicos/uso terapêutico , Feminino , Glucocorticoides/uso terapêutico , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Sarcoidose/tratamento farmacológico , Sarcoidose/patologia , Distribuição por Sexo , Dermatopatias/tratamento farmacológico , Dermatopatias/patologia
2.
Clin Exp Rheumatol ; 37(6): 1052-1064, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31498063

RESUMO

In sarcoidosis, a rare multiorgan disease of unknown aetiology characterised by non-caseating epitheloid cell granulomas, three geoepidemiological factors are major aetiopathogenic factors: geolocation, ethnicity, and personal environment. Geographically, sarcoidosis is mainly reported in the Northern Hemisphere, with the highest incidence rates uniformly reported in countries located at the highest latitudes. The main geoepidemiological-driven differences across the world are of greater female involvement in Southern Europe, the Southern US and Japan, a differentiated radiological pattern (predominance of stage I in Southern Europe and Middle East/Asia and of stage II in Northern Europe, China and India, with the US and Japan having the highest frequencies of stages III/IV) and the extrathoracic phenotype: the most frequent extrathoracic organs involved are the skin in Southern Europe and Middle East/Asia, the eyes in Northern Europe, Northeast US and Japan, the liver in India and the lymph nodes in China. In addition, there are large ethnicity-driven variations in the frequency, epidemiology, clinical expression and outcome of sarcoidosis. The highest incidence rates are uniformly reported in Black/African-American people, independently of the geographical location, with rates between 2- and 10-fold higher than those reported in White people living in the same geographical area. Furthermore, ethnicity heavily influences the clinical phenotype by modifying the age at diagnosis and the rates of thoracic and extrathoracic involvements. Geoepidemiological studies enhanced by big data may yield important clues to understanding the role of these factors in the frequency and clinical phenotypes of sarcoidosis.


Assuntos
Grupos Étnicos , Sarcoidose , Distribuição por Idade , Ásia , Big Data , China , Grupos Étnicos/estatística & dados numéricos , Europa (Continente) , Feminino , Humanos , Índia , Japão , Masculino , Sarcoidose/epidemiologia , Sarcoidose/etnologia , Distribuição por Sexo
3.
Autoimmun Rev ; 18(9): 102351, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31323361

RESUMO

OBJECTIVE: Uveitis is the most common ophthalmological finding in the practice of rheumatology and clinical immunology. The condition is frequently idiopathic but about 60 causes of uveitis have been described. Our aim was to analyze the clinical patterns and etiologies of uveitis in a tertiary referral center. METHODS: The records of 912 consecutive patients referred to the department of internal medicine (Lyon University Hospital, Lyon, France) for the diagnostic work-up of uveitis were examined. Demographic, clinical, anatomical, and etiological features of uveitis were analyzed. RESULTS: The mean age at onset was 48.8 years; 59.8% of the patients were women and 78.2% were Caucasians. Anterior uveitis was the most common type of uveitis (40.6%), followed by panuveitis (31.7%), posterior (18.75%) and intermediate uveitis (9%). 46.9% of the patients had idiopathic uveitis. The most common etiologies were systemic diseases (37.3%), such as sarcoidosis (17.1%), HLA-B27-related uveitis and/or spondyloarthritis (12.5%), and tuberculosis (7.5%). CONCLUSION: We describe one of the largest cohorts of consecutive uveitis patients referred to a department of internal medicine. The high percentage of uveitis associated with underlying (systemic) diseases highlights the need for a multidisciplinary approach, in order to reduce the diagnostic delay.


Assuntos
Autoimunidade/fisiologia , Uveíte/epidemiologia , Uveíte/imunologia , Doença Aguda , Adulto , Idoso , Diagnóstico Tardio , Feminino , França/epidemiologia , Antígeno HLA-B27/genética , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Reumatologia , Sarcoidose/complicações , Sarcoidose/epidemiologia , Espondilartrite/complicações , Espondilartrite/epidemiologia , Centros de Atenção Terciária , Uveíte/complicações , Uveíte/genética
4.
J Evid Based Med ; 12(3): 194-199, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31218829

RESUMO

BACKGROUND/OBJECTIVES: Several epidemiologic studies have suggested that patients with celiac disease may be at an increased risk of sarcoidosis but the results were inconsistent. This systematic review and meta-analysis was conducted with the aim to better characterize this risk by summarizing all available data. METHODS: A literature review was performed using MEDLINE and EMBASE database from inception to February 2019. Studies that compared the risk of sarcoidosis among patients with celiac disease versus individuals without celiac disease were included. Pooled odds ratio (OR) and 95% confidence interval (CI) were calculated using a random-effect, generic inverse variance method. RESULTS: Of 426 retrieved studies, four studies with 693 639 participants met the eligibility criteria and were included in meta-analysis. The risk of sarcoidosis among patients with celiac disease was higher than individuals without celiac disease with the pooled OR of 7.16 (95% CI, 1.48-34.56). The statistical heterogeneity of this study was high (I2  = 95%). CONCLUSIONS: This systematic review and meta-analysis found a significantly higher risk of sarcoidosis among patients with celiac disease.


Assuntos
Doença Celíaca/epidemiologia , Doença Celíaca/imunologia , Sarcoidose/epidemiologia , Sarcoidose/imunologia , Doença Celíaca/diagnóstico , Comorbidade , Intervalos de Confiança , Humanos , Razão de Chances , Prevalência , Prognóstico , Medição de Risco , Sarcoidose/diagnóstico
5.
Clin Dermatol ; 37(3): 240-254, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31178106

RESUMO

Sarcoidosis is a chronic multisystemic, inflammatory disease with specific granulomatous cutaneous lesions. The cutaneous form may be considered a "great imitator," due to its extensive clinical morphology that occurs in upwards of 20% to 35% of patients. Cutaneous lesions may have a variety of presentations including papules, plaques, nodules, infiltrative scars, annular, angiolupoid, psoriasiform, hypopigmented, atrophic, ulcerative lesions, scarring and nonscarring alopecia, erythroderma, and ichthyosiform lesions. The dermatopathology is generally the same for all of the clinical presentations; however, variations in the cutaneous findings cause confusion in following a clinical course, therapeutic approach, or prognosis.


Assuntos
Sarcoidose , Dermatopatias , Pele/patologia , Corticosteroides/administração & dosagem , Hormônio Adrenocorticotrópico/administração & dosagem , Idade de Início , Antimaláricos/uso terapêutico , Fatores Biológicos/uso terapêutico , Diagnóstico Diferencial , Feminino , Humanos , Infliximab/uso terapêutico , Injeções , Masculino , Mercaptopurina/análogos & derivados , Mercaptopurina/uso terapêutico , Metotrexato/uso terapêutico , Prognóstico , Rituximab/administração & dosagem , Sarcoidose/diagnóstico , Sarcoidose/epidemiologia , Sarcoidose/etiologia , Sarcoidose/patologia , Dermatopatias/diagnóstico , Dermatopatias/etiologia , Dermatopatias/patologia , Talidomida/uso terapêutico
6.
Drug Discov Ther ; 13(2): 96-100, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31080209

RESUMO

Oligoarticular arthritis (inflammation of upto 4 joints) has a wide range of infectious and non-infectious etiologies. The aim of our study was to identify the features which could help in the differentiation of infectious from non-infectious arthritis. The study was prospective and observational, and included 100 patients with oligoarticular inflammatory arthritis. The final diagnosis was made using standard diagnostic criteria and the patients were categorized into infectious and non-infectious groups. Among the 100 patients who were recruited, the following final diagnosis were made: peripheral spondyloarthritis (n = 37), axial spondyloarthritis (n = 11), tuberculosis (n = 19), brucellosis (n = 6), septic arthritis (n = 6), gouty arthritis (n = 5), early rheumatoid arthritis (n = 5), non-tubercular mycobacteria (n = 2), SLE (n = 2), post-chikungunya arthritis (n = 2), acute lymphocytic leukaemia (n = 1), pachydermoperiostosis (n = 1), sarcoidosis (n = 1) and juvenile idiopathoic arthritis (n = 1). The patients were categorized into two groups: infectious (33) and non-infectious (60). The presence of monoarthritis, clinically-significant weight loss, hepatomegaly, splenomegaly and erosive arthritis were significantly more common in the infectious group as compared to the non-infectious group.


Assuntos
Artrite Infecciosa/epidemiologia , Artrite/classificação , Doenças não Transmissíveis/epidemiologia , Adolescente , Adulto , Artrite/diagnóstico , Artrite Gotosa/diagnóstico , Artrite Gotosa/epidemiologia , Artrite Infecciosa/diagnóstico , Artrite Juvenil/diagnóstico , Artrite Juvenil/epidemiologia , Artrite Reumatoide/diagnóstico , Artrite Reumatoide/epidemiologia , Brucelose/diagnóstico , Brucelose/epidemiologia , Feminino , Humanos , Índia , Lúpus Eritematoso Sistêmico/diagnóstico , Lúpus Eritematoso Sistêmico/epidemiologia , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Sarcoidose/epidemiologia , Espondilartrite/diagnóstico , Espondilartrite/epidemiologia , Centros de Atenção Terciária , Tuberculose/diagnóstico , Tuberculose/epidemiologia , Adulto Jovem
7.
Medicine (Baltimore) ; 98(21): e15779, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31124970

RESUMO

To assess characteristics and outcomes of patients hospitalized with interstitial lung diseases (ILD) and to analyze patient's comorbidities, procedures, and in-hospital outcomes.We identified patients hospitalized with idiopathic pulmonary fibrosis and others ILD such as hypersensitivity pneumonitis, cryptogenic organizing pneumonia, lymphangioleiomyomatosis, pulmonary Langerhans cell histiocytosis, and sarcoidosis in Spain during 2014 and 2015.We identified 14,565 discharges among patients admitted for ILD in Spain during the study period: idiopathic pulmonary fibrosis (IPF) in 42.32% (n = 6164), sarcoidosis in 37.65% (n = 5484), hypersensitivity pneumonitis in 10.55% (n = 1538), cryptogenic organizing pneumonia in 7.06% (n = 1028), pulmonary Langerhans cell histiocytosis in 1.48% (n = 215), and lymphangioleiomyomatosis in 0.94% (n = 136). The most common associated comorbidities according to those included in the Charlson Comorbidity Index (CCI) were COPD, diabetes, and congestive heart disease. The presence of pulmonary hypertension increased the probability of dying in patients with idiopathic pulmonary fibrosis (OR 1.36; 95%CI 1.06-1.73). Patients with cryptogenic organizing pneumonia had the longest length of hospital stay and the highest percentage of hospital readmissions (23.64%). The highest IHM corresponded to the idiopathic pulmonary fibrosis (14.94%). Computed tomography of the chest was the procedure more used during admissions for ILD.IPF was responsible for larger percentage of hospital admission among ILD in our study. In addition, the IHM were higher in IPF patients in comparison with those with other ILD. The most common associated comorbidity in ILD according to those included in the CCI was COPD. Computed tomography of the chest was the procedure more frequently used.


Assuntos
Diabetes Mellitus/epidemiologia , Insuficiência Cardíaca/epidemiologia , Hospitalização/estatística & dados numéricos , Doenças Pulmonares Intersticiais/epidemiologia , Doença Pulmonar Obstrutiva Crônica/epidemiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Alveolite Alérgica Extrínseca/diagnóstico por imagem , Alveolite Alérgica Extrínseca/epidemiologia , Criança , Comorbidade , Pneumonia em Organização Criptogênica/diagnóstico por imagem , Pneumonia em Organização Criptogênica/epidemiologia , Feminino , Histiocitose de Células de Langerhans/diagnóstico por imagem , Histiocitose de Células de Langerhans/epidemiologia , Mortalidade Hospitalar , Humanos , Fibrose Pulmonar Idiopática/diagnóstico por imagem , Fibrose Pulmonar Idiopática/epidemiologia , Pulmão/diagnóstico por imagem , Doenças Pulmonares Intersticiais/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Sarcoidose/diagnóstico por imagem , Sarcoidose/epidemiologia , Espanha/epidemiologia , Tomografia Computadorizada por Raios X/estatística & dados numéricos , Adulto Jovem
8.
Artigo em Inglês | MEDLINE | ID: mdl-31126090

RESUMO

Sarcoidosis is a systemic granulomatous disease of unknown etiology. It may develop in response to an exposure or inflammatory trigger in the background of a genetically primed abnormal immune response. Thus, genetic studies are potentially important to our understanding of the pathogenesis of sarcoidosis. We developed a case-control study which explored the genetic variations between firefighters in the Fire Department of the City of New York (FDNY) with World Trade Center (WTC)-related sarcoidosis and those with WTC exposure, but without sarcoidosis. The loci of fifty-one candidate genes related to granuloma formation, inflammation, immune response, and/or sarcoidosis were sequenced at high density in enhancer/promoter, exonic, and 5' untranslated regions. Seventeen allele variants of human leukocyte antigen (HLA) and non-HLA genes were found to be associated with sarcoidosis, and all were within chromosomes 1 and 6. Our results also suggest an association between extrathoracic involvement and allele variants of HLA and non-HLA genes found not only on chromosomes 1 and 6, but also on chromosomes 16 and 17. We found similarities between genetic variants with WTC-related sarcoidosis and those reported previously in sporadic sarcoidosis cases within the general population. In addition, we identified several allele variants never previously reported in association with sarcoidosis. If confirmed in larger studies with known environmental exposures, these novel findings may provide insight into the gene-environment interactions key to the development of sarcoidosis.


Assuntos
Exposição Ambiental/efeitos adversos , Doenças Profissionais/epidemiologia , Exposição Ocupacional/efeitos adversos , Sarcoidose/epidemiologia , Sarcoidose/genética , Ataques Terroristas de 11 de Setembro , Adulto , Estudos de Casos e Controles , Exposição Ambiental/estatística & dados numéricos , Feminino , Bombeiros/estatística & dados numéricos , Humanos , Masculino , Cidade de Nova Iorque/epidemiologia , Exposição Ocupacional/estatística & dados numéricos
9.
Ocul Immunol Inflamm ; 27(6): 897-904, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31020877

RESUMO

Purpose: To describe the clinical experience with retinal vasculitis at 4 Egyptian tertiary eye centers. Methods: A multicenter retrospective chart review of all patients with retinal vasculitis encountered at 4 ocular inflammation referral clinics in Egypt between February 2013 and February 2018. Results: The study included 618 patients (327 males and 291 females). Of these, 284 patients had isolated retinal vasculitis, whereas 233 patients had an associated systemic inflammatory disease, the most frequent being Behçet's disease, followed by sarcoidosis. In 101 patients, retinal vasculitis could be attributed to an infectious etiology, and among this category, the most common was tuberculosis, followed by toxoplasmosis. Conclusion: In our Egyptian cohort, more than half the patients had their retinal vasculitis as part of a serious systemic disease, or as part of an infectious process, as tuberculosis. And in view of the significant potential morbidity of these conditions, the local ophthalmologists need to be aware of these entities when faced with patients presenting with retinal vasculitis.


Assuntos
Hospitais Especializados/estatística & dados numéricos , Oftalmologia/estatística & dados numéricos , Vasculite Retiniana/epidemiologia , Atenção Terciária à Saúde/estatística & dados numéricos , Adolescente , Adulto , Idoso , Síndrome de Behçet/epidemiologia , Criança , Pré-Escolar , Estudos de Coortes , Egito/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Vasculite Retiniana/diagnóstico , Estudos Retrospectivos , Sarcoidose/epidemiologia , Toxoplasmose Ocular/epidemiologia , Tuberculose Ocular/epidemiologia
10.
Med Clin North Am ; 103(3): 527-534, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30955519

RESUMO

Sarcoidosis is a multisystemic granulomatous disease that affects individuals worldwide. The lungs are most commonly involved but any organ can be involved. It has variable manifestations and clinical course. Diagnosis of sarcoidosis is based on clinicopathologic findings and the exclusion of other causes of granulomatous disease. Its hallmark is the formation of granulomas in affected organs. Immunosuppressive therapy is the cornerstone of the management of sarcoidosis and is indicated when there is evidence of symptomatic or progressive disease or when critical organs (ocular, cardiac, nervous system) are involved.


Assuntos
Sarcoidose/diagnóstico , Sarcoidose/terapia , Humanos , Sarcoidose/epidemiologia , Sarcoidose/etiologia
11.
Pol J Vet Sci ; 22(1): 25-29, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30997762

RESUMO

BACKGROUND: Equine sarcoids are the most common neoplasms in horses. Bovine papilloma- virus type 1 (BPV-1) is the main viral type identified in equine sarcoids in Europe. OBJECTIVE: The aim of the present study was to genetically evaluate BPV types based on DNA analyses of the CDS of the L1 gene. The presence of BPV DNA was confirmed by Degenerate Oligonucleotide-Primed Polymerase Chain Reaction (DOP PCR) with FAP59/FAP64 consensus primers. RESULTS: The DNA was detected in 21/40 (52.5%) of clinically diagnosed sarcoids. More than half of 14 isolates (66.7%) shared 100% homology with BPV-1 Deltapapillomavirus 4 isolate 09 asi UK (Acc. No. MF384289) and 99% nucleotide identity with BPV-1 isolate EqSarc1 (Acc. No. JX678969). A comparison with BPV-1 isolate EqSarc1 revealed one silent mutation in C5827T which did not change the aminoacid codon. The remaining 6 isolates (28.6%) shared 100% nucleotide identity with the BPV-1 (Acc. No. X02346) "wild type" isolate, and 1 isolate (4.8%) demonstrated 99% nucleotide identity with BPV-2 (Acc. No. M20219). CONCLUSIONS: Variants of BPV-1 isolate EqSarc1 (Acc. No. JX678969) constitute the most prevalent type of BPV-1 in Polish horses.


Assuntos
Papillomavirus Bovino 1/isolamento & purificação , Doenças dos Cavalos/virologia , Infecções por Papillomavirus/veterinária , Sarcoidose/veterinária , Neoplasias Cutâneas/veterinária , Animais , Papillomavirus Bovino 1/genética , DNA Viral/isolamento & purificação , Doenças dos Cavalos/epidemiologia , Cavalos , Infecções por Papillomavirus/epidemiologia , Infecções por Papillomavirus/virologia , Polônia , Reação em Cadeia da Polimerase/veterinária , Sarcoidose/epidemiologia , Sarcoidose/virologia , Neoplasias Cutâneas/epidemiologia , Neoplasias Cutâneas/virologia
12.
Paediatr Respir Rev ; 29: 53-59, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30917882

RESUMO

Paediatric sarcoidosis is an extremely rare disease characterized by a granulomatous inflammation. The estimated incidence is 0.6-1.02/100,000 children, but in the absence of international registers, the disease is probably under-reported. Its pathophysiologic basis is not clearly understood but the current hypothesis is a combination of a genetic predisposition and an environmental exposure that could be either organic or mineral. Contrary to adult forms of the disease, general symptoms are often at the forefront at diagnosis. In its most frequent form, paediatric sarcoidosis is a multi-organ disorder affecting preferentially the lungs, the lymphatic system and the liver, but all organs can be affected. This review aims to provide an overview of current knowledge on sarcoidosis in children, providing a summary of the data available from cohort studies on the presentation, the management and the evolution of the disease in this specific population.


Assuntos
Sarcoidose Pulmonar/epidemiologia , Adolescente , Criança , Pré-Escolar , Progressão da Doença , Predisposição Genética para Doença , Humanos , Lactente , Pulmão/diagnóstico por imagem , Pulmão/patologia , Sarcoidose/diagnóstico , Sarcoidose/epidemiologia , Sarcoidose/fisiopatologia , Sarcoidose/terapia , Sarcoidose Pulmonar/diagnóstico , Sarcoidose Pulmonar/fisiopatologia , Sarcoidose Pulmonar/terapia
13.
Eur Arch Otorhinolaryngol ; 276(7): 1969-1974, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30900021

RESUMO

BACKGROUND: Sarcoidosis is a chronic disease, which predominantly affects the lung. Since sinonasal sarcoidosis is rare, little is known about the sarcoidosis manifestation at this site. Therefore, the aim of our study was to detect the prevalence of sinonasal sarcoidosis, its clinical occurrence, diagnosis, and therapy. METHODS: The database of all patients having visited the otorhinolaryngology departments of the universities in Göttingen and in Bonn between 2003 and 2016 was searched for the diagnosis of sinonasal sarcoidosis. RESULTS: Thirteen patients with a biopsy-proven sinonasal sarcoidosis were identified. Most patients presented non-specific clinical symptoms, which are also found in acute and chronic sinusitis. None of the patients was suspected to have sinonasal sarcoidosis by the ENT doctor before histological validation. The mean diagnostic delay was 262 (± 195) days. An additional pulmonary involvement was detected in four of six patients. CONCLUSIONS: Sinonasal sarcoidosis is presenting with heterogeneous clinical presentations. An early biopsy of granulomatous lesions is mandatory. A multidisciplinary approach is needed to exclude serious lung or heart manifestations, because even asymptomatic organ involvement is possible. A CT-scan may be useful even if unspecific. Local or systemic therapy has to be prepared individually using local and systemic corticosteroids, antimetabolites, or anti-TNF-alpha.


Assuntos
Doenças dos Seios Paranasais , Seios Paranasais , Sarcoidose , Biópsia/métodos , Diagnóstico Tardio/prevenção & controle , Feminino , Alemanha/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Doenças dos Seios Paranasais/diagnóstico , Doenças dos Seios Paranasais/epidemiologia , Doenças dos Seios Paranasais/terapia , Seios Paranasais/diagnóstico por imagem , Seios Paranasais/patologia , Administração dos Cuidados ao Paciente/métodos , Sarcoidose/diagnóstico , Sarcoidose/epidemiologia , Sarcoidose/terapia , Tomografia Computadorizada por Raios X/métodos
14.
Rev Esp Salud Publica ; 932019 Mar 25.
Artigo em Espanhol | MEDLINE | ID: mdl-30907380

RESUMO

OBJECTIVE: Immune-mediated inflammatory diseases (IMID) are chronic and highly disabling diseases that share inflammatory sequences and immunological dysregulations. Considered as a disease in itself, the prevalence of IMID is virtually unknown. The aim of this study was to assess the prevalence of 10 selected UDI, including rheumatoid arthritis, psoriasis, psoriatic arthritis, ankylosing spondylitis, ulcerative colitis, Crohn's disease, systemic lupus erythematosus, hidradenitis suppurativa, sarcoidosis and uveitis in Spain. METHODS: cross-sectional epidemiological study of point prevalence was made. This study was carried out through a series of computerized interviews in households chosen at random in 17 autonomous communities in Spain. A structured questionnaire was used to determine the frequency of diagnosis and the concurrence of 10 IMID in the respondents and other individuals belonging to the same family nucleus. The point prevalence estimates were used and compared with the objective of determining the frequency of IMID by age, sex and communities. The data were processed using Excel 2016 (Microsoft, Redmond, WA, USA) and the SPSS V.019 system (IBM Corp. Armonk, NY, USA) for statistical analysis using the usual statistical tests in this type of studies. RESULTS: Of the 7,980 respondents, 510 were diagnosed with an IMID, representing a cross-sectional study of 6.39% (95% CI: 6.02-6.76). One, two, three or more members of the family were affected in 87.2%, 7.8% and 5% of positive relatives in IMID, respectively. The most recurrent diseases were psoriasis (2.69% [95% CI: 2.32-3.06]) and rheumatic arthritis (1.07% [95% CI: 0.70-1.44]). There were differences in prevalence due to sex (p = 0.004) and age (p = 0.000). No significant differences were identified related to geographic location (p = 0.819). Attendance of at least 2 IMID was reported in 8.9% of respondents. CONCLUSIONS: The overall prevalence was of the IMID studied was 6.39%, psoriasis being the most frequent with 2.69%. This study constitutes an initial step to consider IMID as an independent disease within the health system..


Assuntos
Artrite/epidemiologia , Hidradenite Supurativa/epidemiologia , Doenças Inflamatórias Intestinais/epidemiologia , Lúpus Eritematoso Sistêmico/epidemiologia , Sarcoidose/epidemiologia , Uveíte/epidemiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Artrite/imunologia , Estudos Transversais , Feminino , Hidradenite Supurativa/imunologia , Humanos , Doenças Inflamatórias Intestinais/imunologia , Lúpus Eritematoso Sistêmico/imunologia , Masculino , Pessoa de Meia-Idade , Prevalência , Sarcoidose/imunologia , Espanha/epidemiologia , Uveíte/imunologia , Adulto Jovem
15.
J Fr Ophtalmol ; 42(3): 303-321, 2019 Mar.
Artigo em Francês | MEDLINE | ID: mdl-30850198

RESUMO

Sarcoidosis is a systemic granulomatosis characterized by the formation of epithelioid and giant cell granulomas without caseous necrosis. To make the diagnosis, it is necessary to prove systemic granulomatosis involving at least two organs; but in practice, a combination of clinical, paraclinical and histologic findings is used. It affects predominantly women with a bimodal age distribution: 25-29years and 65-69years. The most commonly affected organs are the mediastinal lymphatic system, lungs, skin and eyes. Ophthalmological involvement is present in 20 to 50% of cases. The typical ocular presentation is that of granulomatous uveitis associated with venous retinal vasculitis and lesions of peripheral multifocal choroiditis. This ophthalmological presentation, although very evocative, is not always associated with systemic disease. The diagnosis of ocular sarcoidosis is then presumed in the absence of histological evidence. Algorithms combining ophthalmological and systemic signs have been proposed in cases of isolated uveitis. They make it possible to establish the diagnosis of ocular sarcoidosis with various levels of probability. The absence of significant granulomas on a systemic level during primary ocular involvement remains the main hypothesis to explain these diagnostic difficulties. Treatment is well described, as the uveitis of sarcoidosis is most often steroid responsive. In the case of corticosteroid-dependent uveitis, the first-line immunosuppressant remains methotrexate. The use of anti-tumor necrosis factor-alpha is an interesting alternative in patients whose ocular sarcoidosis is refractory to conventional immunosuppressants.


Assuntos
Sarcoidose , Adulto , Distribuição por Idade , Idoso , Corioidite/diagnóstico , Corioidite/epidemiologia , Diagnóstico Diferencial , Técnicas de Diagnóstico Oftalmológico , Endoftalmite/diagnóstico , Endoftalmite/epidemiologia , Granuloma/diagnóstico , Granuloma/epidemiologia , Humanos , Vasculite Retiniana/diagnóstico , Vasculite Retiniana/epidemiologia , Sarcoidose/diagnóstico , Sarcoidose/epidemiologia , Sarcoidose/patologia , Uveíte/diagnóstico , Uveíte/epidemiologia
16.
Lung ; 197(2): 155-161, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30778661

RESUMO

PURPOSE: The clinical manifestations of sarcoidosis vary widely, depending on the intensity of the inflammation and the organ systems affected. Hence, sarcoidosis patients may suffer from a great variety of symptoms. The aim of this study was to compare the self-reported burden of sarcoidosis patients in Denmark, Germany and the Netherlands, especially the prevalence of fatigue and small fiber neuropathy (SFN)-related symptoms, as well as differences in treatment strategies. METHODS: A cross-sectional web-based anonymous survey about complaints was conducted among sarcoidosis patients. Patients were invited to take part through the sarcoidosis patient societies as well as through outpatient sarcoidosis clinics in these countries. RESULTS: The questionnaire was completed by 1072 sarcoidosis patients (152 Danish, 532 German and 388 Dutch). Almost all patients reported having sarcoidosis-associated symptoms (organ-related as well as non-specific, non-organ related). Fatigue was reported by almost all respondents (90%), followed by pulmonary symptoms (72.4%). More than 50% of the respondents were being treated with prednisone, which was comparable in all three countries. In contrast, second- and third-line treatment differed substantially between Denmark, Germany and the Netherlands. CONCLUSION: Sarcoidosis patients in Denmark, Germany and the Netherlands present with similar self-reported symptoms, organ-related as well as non-specific, non-organ related. Fatigue (90%) and symptoms associated with SFN (86%) were highly prevalent in all three countries.


Assuntos
Efeitos Psicossociais da Doença , Sarcoidose/epidemiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Estudos Transversais , Progressão da Doença , Europa (Continente)/epidemiologia , Feminino , Glucocorticoides/uso terapêutico , Inquéritos Epidemiológicos , Humanos , Masculino , Pessoa de Meia-Idade , Prednisona/uso terapêutico , Prevalência , Prognóstico , Sarcoidose/diagnóstico , Sarcoidose/tratamento farmacológico , Adulto Jovem
17.
Lung ; 197(2): 165-171, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30798420

RESUMO

PURPOSE: To investigate inpatient prevalence, expenditures, and comorbidities of hospitalized patients with sarcoidosis in the USA. METHODS: Patients with sarcoidosis were identified within the Nationwide Inpatient Sample (NIS) database for the years 2013 and 2014 using the respective ICD-9 diagnostic code. Data on patient and hospital characteristics, comorbidities, total hospital costs, and total hospitalization charges were collected. A propensity-matched cohort of patients without sarcoidosis from the same database was created and used as comparators for the analysis of comorbidities. RESULTS: A cohort of 78,055 patients with sarcoidosis was identified within the database, corresponding to an inpatient prevalence of 2.21 cases per 1000 admissions. Analysis of comorbidities found that patients with sarcoidosis had significantly higher odds of atrial fibrillation [adjusted odds ratio (aOR): 1.41, 95% CI 1.13-1.76, p < 0.01], conduction abnormalities [aOR: 2.04, 95% CI 1.45-2.89, p < 0.01], aortic valvulopathy [aOR: 1.78, 95% CI 1.30-2.44, p < 0.01], congestive heart failure [aOR: 1.23, 95% CI 1.04-1.45, p = 0.02], cardiomyopathy [aOR: 1.25, 95% CI 1.08-1.44, p < 0.01], deep venous thrombosis (aOR: 1.58, p < 0.01), pulmonary embolism (aOR: 1.70, p < 0.01), and osteoporosis (aOR: 1.81, p < 0.01), compared with propensity-matched patients without sarcoidosis. After adjusting for confounders, patients with sarcoidosis displayed a mean additional $1,250 (p = 0.24) in total hospital costs and a mean additional $27,205 (p < 0.01) in total hospitalization charges when compared to hospitalized patients without sarcoidosis. CONCLUSIONS: The inpatient prevalence of sarcoidosis was relatively high compared with its overall incidence. Hospitalization of patients with sarcoidosis was associated with a significantly higher total hospitalization charges compared to hospitalized patients without sarcoidosis. Patients with sarcoidosis have a higher risk of several cardiac comorbidities.


Assuntos
Gastos em Saúde , Custos Hospitalares , Pacientes Internados , Sarcoidose/economia , Sarcoidose/epidemiologia , Comorbidade , Estudos Transversais , Bases de Dados Factuais , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Prevalência , Estudos Retrospectivos , Fatores de Risco , Sarcoidose/diagnóstico , Sarcoidose/terapia , Estados Unidos/epidemiologia
18.
Am J Med Sci ; 357(2): 93-102, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30665498

RESUMO

Sarcoidosis is a chronic inflammatory disease of uncertain etiology characterized by the formation of noncaseating granulomas. The thorax is involved in 95% of cases, but any organ can be involved. Sinonasal or laryngeal involvement is uncommon and can be difficult to diagnose. The reported incidence of sarcoidosis in the upper airway clearly depends on study characteristics, and this creates uncertainty about the actual incidence. In a large prospective study in the United States, upper respiratory tract involvement occurred in 3% of the patients. Some patients have upper airway involvement without thoracic disease, and this presentation may cause delays in diagnosis. These patients have nonspecific symptoms which range from minimal nasal stuffiness to life-threatening upper airway obstruction. Currently, there is no established standard therapy for the management of upper airway sarcoidosis. These patients often respond poorly to nasal and/or inhaled corticosteroids and require long courses of oral corticosteroids. Patients with poor responses to oral corticosteroids or severe side effects may respond to tumor necrosis factor alpha inhibitors. In this review, we will discuss the clinical presentation, pathogenesis, diagnostic tests, drug treatment, surgical management options and the challenges clinicians have managing these patients.


Assuntos
Doenças da Laringe , Doenças Nasais , Sarcoidose , Humanos , Doenças da Laringe/diagnóstico , Doenças da Laringe/epidemiologia , Doenças da Laringe/etiologia , Doenças da Laringe/terapia , Doenças Nasais/diagnóstico , Doenças Nasais/epidemiologia , Doenças Nasais/etiologia , Doenças Nasais/terapia , Doenças dos Seios Paranasais/diagnóstico , Doenças dos Seios Paranasais/epidemiologia , Doenças dos Seios Paranasais/etiologia , Doenças dos Seios Paranasais/terapia , Sarcoidose/diagnóstico , Sarcoidose/epidemiologia , Sarcoidose/etiologia , Sarcoidose/terapia
19.
Ocul Immunol Inflamm ; 27(3): 389-395, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-29023165

RESUMO

Purpose: To characterize the epidemiology and clinical characteristics of ocular involvement in patients with systemic sarcoidosis. Methods: An inception cohort of patients with systemic sarcoidosis in 1976-2013 in Olmsted County, Minnesota, was identified based on comprehensive individual medical record review. Medical records of those patients were then reviewed for ocular involvement. Results: A total of 345 incident cases of systemic sarcoidosis were identified. Ocular involvement occurred in 23 patients (7%). The most common ocular disease was uveitis (61%) followed by dry eye disease, conjunctival nodule, episcleritis, anterior scleritis, and conjunctivitis. Anterior uveitis was the most common type of uveitis (71%). The visual outcome of uveitis was favorable with only one patient lost three or more lines of VA during follow-up and had VA of less than 20/200 at last visit. Conclusion: Ocular involvement occurred in 7% of sarcoidosis patients. Uveitis was the most common type of ocular disease.


Assuntos
Oftalmopatias/epidemiologia , Previsões , Vigilância da População , Sarcoidose/complicações , Adulto , Distribuição por Idade , Idoso , Idoso de 80 Anos ou mais , Oftalmopatias/etiologia , Feminino , Seguimentos , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Minnesota/epidemiologia , Prevalência , Estudos Retrospectivos , Sarcoidose/epidemiologia , Distribuição por Sexo
20.
Dermatol Clin ; 37(1): 49-64, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30466688

RESUMO

Inflammatory granulomatous dermatitides include cutaneous sarcoidosis, necrobiosis lipoidica, granuloma annulare, and reactive granulomatous dermatitis. The etiopathogenesis of these disorders is not well understood; but the T helper 1 response mediated by interferon-gamma, tumor necrosis factor-alpha, and interleukin (IL) 1, 2, and 6 and the T helper 17 response mediated by IL-17 play a role. These inflammatory granulomatous disorders often have cutaneous manifestations in addition to extracutaneous manifestations or associations with systemic diseases. The authors review these disorders, propose diagnostic and evaluative approaches to these diseases, and explore recent literature with regard to the etiopathogenesis and treatment of these entities.


Assuntos
Granuloma/patologia , Granuloma/terapia , Sarcoidose/etiologia , Dermatopatias/etiologia , Dermatopatias/terapia , Granuloma/epidemiologia , Granuloma/etiologia , Granuloma Anular/epidemiologia , Granuloma Anular/etiologia , Granuloma Anular/patologia , Granuloma Anular/terapia , Humanos , Necrobiose Lipoídica/epidemiologia , Necrobiose Lipoídica/etiologia , Necrobiose Lipoídica/patologia , Necrobiose Lipoídica/terapia , Sarcoidose/epidemiologia , Sarcoidose/patologia , Dermatopatias/epidemiologia , Dermatopatias/patologia
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