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Sarcoidosis. Disease progression based on radiological and functional course: Predictive factors

      BULLET POINTS

      • The course of sarcoidosis is highly variable. Whereas half of the cases resolve spontaneously in two years, at three years a third of patients may have pulmonary progression.
      • Age at diagnosis was the only variable associated with disease prognosis.
      • Patients diagnosed at a certain age (e.g. 50 years) should be followed more closely.
      • Further studies are needed to improve definitions and intervals of disease progression and to validate these results.

      Abstract

      Background

      Sarcoidosis is a multiorgan granulomatous disease with a variable course.

      Oobjectives

      The purpose of this study is to identify the patients that are more likely to experience disease progression.

      Methods

      A retrospective study in patients ≥18 years. Pulmonary function and radiological stage (Scadding criteria) were assessed at diagnosis, and at 1, 3 and 5 years. Sarcoidosis progression was established based on deterioration of radiological or pulmonary function (decrease ≥10% of FVC and/or ≥15% of diffusing capacity of the lung (DLCO).

      Results

      The sample included 277 caucasian patients [mean age, 50±13.6; 69.7% between 31-60 years; 56.3% men]. In total, 65% had stage II sarcoidosis, whereas only 8.3% had stage III/IV disease. Mean pulmonary function (FVC, FEV1, FEV1/FVC and DLCO) at diagnosis was 103±21.8, 96±22.2, 76.2±8 and 81.7±21.7, respectively. The percentage of patients with normal FVC and DLCO was 72.2% and 51.8%, respectively. Radiological stage did not change significantly during follow-up (5 years; p=0.080) and only progressed in 13 patients (5.7%). At 3 years, FVC improved, whereas DLCO exacerbated significantly (p<0.001 for the two). Disease progressed in 34.5% of the patients (57/165) whose pulmonary function and radiological stage were available (both baseline and at 3 years). Age was associated with disease progression [OR=1.04 (95%CI=1.01, 1.06)]. Risk increased by 4% for each year older a patient was at diagnosis.

      Conclusions

      At 3 years, a third of patients experienced sarcoidosis progression. Age was the only factor associated with disease prognosis.

      Keywords

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