Sarcoidosis Follow-up

  • Author: Nader Kamangar, MD, FACP, FCCP, FCCM; Chief Editor: Zab Mosenifar, MD   more...
 
Updated: Jul 29, 2011
 

Further Inpatient Care

  • Monitor pulmonary function and CXR every 6-12 months.
  • Assess for progression or resolution.
  • Determine if previously uninvolved organs have become affected.
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Further Outpatient Care

  • Annual slit lamp eye examination and ECG are recommended.
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Prognosis

Many patients do not require therapy, and their conditions will spontaneously improve. Markers for a poor prognosis include advanced CXR stage, extrapulmonary disease (predominantly cardiac and neurologic), and evidence of pulmonary hypertension. Multiple studies have demonstrated that the most important marker for prognosis is the initial CXR stage (see Table 2).

Table 1. Prognosis (Open Table in a new window)

StageRemission (%)Asymptomatic at 5 y (%)CXR Clearing (%)Mortality (%)
Stage I60-9095540
Stage II40-70583111
Stage III10-20251018
Stage IV0N/A0N/A

Although corticosteroids are used for symptom relief and remain the mainstay of therapy, their efficacy in this disease is unclear. A meta-analysis suggests that corticosteroids have little impact on sarcoidosis. However, prior studies have been hampered by their uncontrolled nature, small sample size, and the variable natural history of the disease. Since many patients' conditions improve spontaneously, showing a true benefit to therapy requires a careful control arm.

The best study addressing corticosteroids was the recently completed multicenter trial from Britain sponsored by the British Thoracic Society. In this nonrandomized study, 55 patients were selectively observed or treated with corticosteroids. Additionally, patients who were felt to have an immediate indication for steroids were treated an observed. The trial required a 6-month run-in period to exclude patients who improved spontaneously. At the end of the trial, the groups treated with long-term steroids fared better on some measures than did the patients who were observed and treated with short bursts of steroids (see the table below for greater detail).

Table 2. Results of Multicenter Trial Sponsored by the British Thoracic Society (Open Table in a new window)

CharacteristicsGroup L*Group S†P
Dyspnea score (range 1-4)0.240.47NS
Fibrosis score (range 0-16)0.831.47NS
FEV1‡ (% predicted)95.986.90.05
VC§ (% predicted)99.890.80.02
DLCOII (% predicted)84.377.7NS
Weight gain (kg)+3.26+0.990.02
*Long-term steroids



†Short bursts of steroids



‡Forced expiratory volume in 1 second



§Ventilatory capacity



II Diffusing capacity of lung for carbon monoxide



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Contributor Information and Disclosures
Author

Nader Kamangar, MD, FACP, FCCP, FCCM  Associate Professor of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, University of California, Los Angeles, David Geffen School of Medicine, Olive View-UCLA Medical Center; Associate Program Director, Pulmonary and Critical Care Multi-Campus Fellowship Program, Cedars-Sinai/West Los Angeles Veterans Affairs/Los Angeles Kaiser Permanente/Olive View-UCLA Medical Center; Site Director, Pulmonary/Critical Care Fellowship Program, Olive View-UCLA Medical Center

Nader Kamangar, MD, FACP, FCCP, FCCM is a member of the following medical societies: American Academy of Sleep Medicine, American Association of Bronchology, American College of Chest Physicians, American College of Physicians, American Lung Association, American Medical Association, American Thoracic Society, California Thoracic Society, and Society of Critical Care Medicine

Disclosure: Nothing to disclose.

Coauthor(s)

Andrew F Shorr, MD, MPH  Assistant Professor, Department of Internal Medicine, Division of Pulmonary and Critical Care, Uniformed Services University of the Health Sciences

Andrew F Shorr, MD, MPH is a member of the following medical societies: American College of Chest Physicians, American College of Physicians, and American Thoracic Society

Disclosure: Nothing to disclose.

Specialty Editor Board

Stephen P Peters, MD, PhD, FACP, FAAAAI, FCCP, FCPP  Professor of Genomics and Personalized Medicine Research, Internal Medicine, and Pediatrics, Associate Director, Center for Genomics and Personalized Medicine Research, Director of Research, Section on Pulmonary, Critical Care, Allergy and Immunologic Diseases, Wake Forest University School of Medicine

Stephen P Peters, MD, PhD, FACP, FAAAAI, FCCP, FCPP is a member of the following medical societies: American Academy of Allergy Asthma and Immunology, American Association of Immunologists, American College of Chest Physicians, American College of Physicians, American Federation for Medical Research, American Thoracic Society, and Sigma Xi

Disclosure: See below for list of all activities None None

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Om Prakash Sharma, MD, FRCP, FCCP, DTM&H  Professor, Department of Medicine, Division of Pulmonary and Critical Care Medicine, University of Southern California Keck School of Medicine

Om Prakash Sharma, MD, FRCP, FCCP, DTM&H is a member of the following medical societies: American Academy of Allergy Asthma and Immunology, American College of Chest Physicians, American College of Physicians, American Federation for Medical Research, American Osler Society, American Thoracic Society, New York Academy of Medicine, and Royal Society of Medicine

Disclosure: Nothing to disclose.

Timothy D Rice, MD  Associate Professor, Departments of Internal Medicine and Pediatrics and Adolescent Medicine, St Louis University School of Medicine

Timothy D Rice, MD is a member of the following medical societies: American Academy of Pediatrics and American College of Physicians

Disclosure: Nothing to disclose.

Chief Editor

Zab Mosenifar, MD  Director, Division of Pulmonary and Critical Care Medicine, Director, Women's Guild Pulmonary Disease Institute, Professor and Executive Vice Chair, Department of Medicine, Cedars Sinai Medical Center, University of California, Los Angeles, David Geffen School of Medicine

Zab Mosenifar, MD is a member of the following medical societies: American College of Chest Physicians, American College of Physicians, American Federation for Medical Research, and American Thoracic Society

Disclosure: Nothing to disclose.

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Stage I sarcoidosis.
Stage II sarcoidosis.
Stage III sarcoidosis.
Noncaseating granuloma.
Table 1. Prognosis
StageRemission (%)Asymptomatic at 5 y (%)CXR Clearing (%)Mortality (%)
Stage I60-9095540
Stage II40-70583111
Stage III10-20251018
Stage IV0N/A0N/A
Table 2. Results of Multicenter Trial Sponsored by the British Thoracic Society
CharacteristicsGroup L*Group S†P
Dyspnea score (range 1-4)0.240.47NS
Fibrosis score (range 0-16)0.831.47NS
FEV1‡ (% predicted)95.986.90.05
VC§ (% predicted)99.890.80.02
DLCOII (% predicted)84.377.7NS
Weight gain (kg)+3.26+0.990.02
*Long-term steroids



†Short bursts of steroids



‡Forced expiratory volume in 1 second



§Ventilatory capacity



II Diffusing capacity of lung for carbon monoxide



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