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Current Opinion in Pulmonary Medicine Sep 2023The current review aims to highlight the role of primary care physicians in the diagnosis, treatment and monitoring of patients with sarcoidosis. Increased awareness of... (Review)
Review
PURPOSE OF REVIEW
The current review aims to highlight the role of primary care physicians in the diagnosis, treatment and monitoring of patients with sarcoidosis. Increased awareness of the clinical and imaging manifestations of the disease as well as the natural disease course will help for earlier and more accurate diagnosis as well as detection of high-risk patients who would benefit from treatment introduction.
RECENT FINDINGS
Recent guidelines have attempted to deal with the confusion related to treatment indications, duration and monitoring of treatment in patients with sarcoidosis. Nonetheless, important points require further clarification. Primary care physicians may be the first to confront disease exacerbation, deterioration despite treatment and/or treatment-induced side effects. Furthermore, they are the physicians that remain closer to the patient providing a significant amount of information, psychological support and assessment for sarcoidosis-specific or not issues. The treatment strategy for each organ is complex, but the principles of treatment have been explored.
SUMMARY
There have been considerable advances in the diagnostic and management approach of patients with sarcoidosis. Multidisciplinary approach for both diagnosis and management seems optimal. Validating risk stratification strategies and standardizing the monitoring process is appropriate for the future.
Topics: Humans; Sarcoidosis; Disease Progression; Primary Health Care
PubMed: 37410457
DOI: 10.1097/MCP.0000000000000991 -
The Journal of Allergy and Clinical... Jul 2023
Topics: Humans; Drug Hypersensitivity; Hypersensitivity, Delayed
PubMed: 37019391
DOI: 10.1016/j.jaci.2023.03.024 -
Current Opinion in Pulmonary Medicine Sep 2023This review provides an assessment of biomarkers in sarcoidosis, aiming to address the need for improved diagnostic, prognostic and management tools. Sarcoidosis... (Review)
Review
PURPOSE OF REVIEW
This review provides an assessment of biomarkers in sarcoidosis, aiming to address the need for improved diagnostic, prognostic and management tools. Sarcoidosis presents diagnostic challenges, necessitating the search for reliable biomarkers to guide clinical decisions.
RECENT FINDINGS
Established biomarkers such as serum angiotensin-converting enzyme (ACE) and serum interleukin-2 receptor (sIL-2R) have limitations in sensitivity and specificity. FDG-PET/CT imaging shows promising results in assessing disease activity and guiding immunosuppression. Gene expression profiling studies reveal potential biomarkers, particularly involving TH1 immune response and IFN-γ-driven signalling pathways. The field of omics sciences offers opportunities for novel biomarker discovery.
SUMMARY
These findings have implications for clinical practice and research. The limitations of established biomarkers underscore the need for improved diagnostic tools in sarcoidosis. The potential of FDG-PET/CT imaging requires further exploration. Gene expression profiling and omics sciences offer avenues for discovering novel biomarkers to enhance diagnosis and predict disease progression. Such advancements can facilitate personalized treatment strategies and improve patient outcomes. Continued research is vital to validate the efficacy and clinical applicability of these biomarkers. Overall, this review emphasizes ongoing efforts to advance sarcoidosis biomarkers research and improve disease management.
Topics: Humans; Precision Medicine; Fluorodeoxyglucose F18; Positron Emission Tomography Computed Tomography; Sarcoidosis; Biomarkers
PubMed: 37410487
DOI: 10.1097/MCP.0000000000000985 -
International Journal of Molecular... Jul 2023In recent years, there has been a noticeable development in oncological treatment, including chemotherapy and biological treatment. Despite their significant... (Review)
Review
In recent years, there has been a noticeable development in oncological treatment, including chemotherapy and biological treatment. Despite their significant effectiveness, they are not free from side effects, such as allergic and dermatological reactions. These reactions can vary in severity and outcome, including potential death. Examples, among others, are type I-IV hypersensitivity reactions of various origins and skin reactions including rashes, itching and redness, but also severe cutaneous syndromes. Due to the therapy used, these may include Stevens-Johnson syndrome, toxic epidermal necrolysis, drug rash with eosinophilia and systemic symptoms, drug-induced hypersensitivity syndrome and acute generalized exanthematous pustulosis. In some cases, it is necessary to interrupt therapy, which may result in a poorer outcome and shorten the patient's survival. This paper reviews various types of research documents published since 2016. It aims to systematize the latest knowledge and highlight the need for further research into ways to avoid adverse reactions.
Topics: Humans; Skin; Stevens-Johnson Syndrome; Acute Generalized Exanthematous Pustulosis; Drug Hypersensitivity Syndrome; Eosinophilia
PubMed: 37511017
DOI: 10.3390/ijms241411257 -
International Journal of Cardiology May 2024Cardiac sarcoidosis (CS) is increasingly recognized in the context of with otherwise unexplained electrical or structural heart disease due to improved diagnostic tools... (Review)
Review
Cardiac sarcoidosis (CS) is increasingly recognized in the context of with otherwise unexplained electrical or structural heart disease due to improved diagnostic tools and awareness. Therefore, clinicians require improved understanding of this rare but fatal disease to care for these patients. The cardinal features of CS, include arrhythmias, atrio-ventricular conduction delay and cardiomyopathy. In addition to treatments tailored to these cardiac manifestations, immunosuppression plays a key role in active CS management. However, clinical trial and consensus guidelines are limited to guide the use of immunosuppression in these patients. This review aims to provide a practical overview to the current diagnostic challenges, treatment approach, and future opportunities in the field of CS.
Topics: Humans; Cardiomyopathies; Arrhythmias, Cardiac; Heart Diseases; Heart; Sarcoidosis; Myocarditis
PubMed: 38373681
DOI: 10.1016/j.ijcard.2024.131853 -
The British Journal of Dermatology May 2024
Topics: Humans; Dermatitis, Allergic Contact; Female; Male; Adult; Middle Aged; Dental Materials; Patch Tests; Aged
PubMed: 38758061
DOI: 10.1093/bjd/ljae160 -
Respiratory Medicine Jan 2024
Topics: Humans; Sarcoidosis, Pulmonary; Cough; Sarcoidosis
PubMed: 38113960
DOI: 10.1016/j.rmed.2023.107483 -
Sleep Medicine Clinics Jun 2024Obstructive sleep apnea (OSA) is very prevalent in sarcoidosis patients. Sarcoidosis of the upper respiratory tract may affect upper airway patency and increase the risk... (Review)
Review
Obstructive sleep apnea (OSA) is very prevalent in sarcoidosis patients. Sarcoidosis of the upper respiratory tract may affect upper airway patency and increase the risk of OSA. Weight gain due to steroid use, upper airway myopathy due to steroids and sarcoidosis itself, and interstitial lung disease with decreased upper airway patency are other reasons for the higher OSA prevalence seen in sarcoidosis. Several clinical manifestations such as fatigue, hypersomnolence, cognitive deficits, and pulmonary hypertension are common to both OSA and sarcoidosis. Therefore, early screening and treatment for OSA can improve symptoms and overall patient quality of life.
Topics: Humans; Sleep Apnea, Obstructive; Sarcoidosis
PubMed: 38692754
DOI: 10.1016/j.jsmc.2024.02.010 -
Current Opinion in Allergy and Clinical... Aug 2023Recent studies have been clarifying the pathogenesis and early diagnostic markers of Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN). Additionally,... (Review)
Review
PURPOSE OF REVIEW
Recent studies have been clarifying the pathogenesis and early diagnostic markers of Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN). Additionally, the efficacy of tumor necrosis factor alpha inhibitors is attracting attention. This review provides) recent evidence for the diagnosis and management of SJS/TEN.
RECENT FINDINGS
Risk factors for the development of SJS/TEN have been identified, particularly the association between HLA and the onset of SJS/TEN with specific drugs, which has been intensively studied. Research on the pathogenesis of keratinocyte cell death in SJS/TEN has also progressed, revealing the involvement of necroptosis, an inflammatory cell death, in addition to apoptosis. Diagnostic biomarkers associated with these studies have also been identified.
SUMMARY
The pathogenesis of SJS/TEN remains unclear and effective therapeutic agents have not yet been established. As the involvement of innate immunity, such as monocytes and neutrophils, in addition to T cells, has become clear, a more complex pathogenesis is predicted. Further elucidation of the pathogenesis of SJS/TEN is expected to lead to the development of new diagnostic and therapeutic agents.
Topics: Humans; Stevens-Johnson Syndrome; Immunologic Factors
PubMed: 37284785
DOI: 10.1097/ACI.0000000000000914 -
Current Opinion in Pulmonary Medicine Sep 2023Clinical presentation and outcomes in patients with sarcoidosis vary by race, gender, ethnicity, and geolocation. African Americans and female individuals have the... (Review)
Review
PURPOSE OF REVIEW
Clinical presentation and outcomes in patients with sarcoidosis vary by race, gender, ethnicity, and geolocation. African Americans and female individuals have the highest incidence of disease. They are also more likely to present with more severe and more advanced forms of disease and to die from sarcoidosis. African American females have the highest disease-associated mortality, yet the mortality rate varies by geolocation. The diverse presentation and outcomes in sarcoidosis have often been attributed to genetics and biology, yet this may not be entirely so.
RECENT FINDINGS
Several studies have shown that African Americans and female individuals are more likely to earn less and be more socioeconomically disadvantaged in society. Patients with sarcoidosis earning in the lowest income strata present with the most severe disease and report more barriers to care. It is plausible that the racial, gender, and geospatial differences in sarcoidosis are more reflective of healthcare disparities than genetics or biology alone.
SUMMARY
Preventable differences in the burden of disease and in the opportunities to achieve optimal health outcomes that are differentially experienced by groups of people disadvantaged by race, gender, ethnicity, or socioeconomic background should be identified and addressed.
Topics: Humans; Female; United States; Sarcoidosis; Ethnicity; Black or African American; Healthcare Disparities; White
PubMed: 37431305
DOI: 10.1097/MCP.0000000000000994