Marc A Judson1, Sara Preston2, Kurt Hu3, Robert Zhang4, Stephanie Jou4, Aakash Modi3, Indrawattie Sukhu3, Furqan Ilyas3, Gavril Rosoklija4, Recai Yucel5. 1. Division of Pulmonary and Critical Care Medicine, Albany Medical College, Albany, NY, USA. Electronic address: judsonm@mail.amc.edu. 2. Division of Pulmonary and Critical Care Medicine, Albany Medical College, Albany, NY, USA; St. George's University School of Medicine, Grenada, West Indies. 3. Division of Pulmonary and Critical Care Medicine, Albany Medical College, Albany, NY, USA. 4. Department of Medicine, Albany Medical Center, Albany, NY, USA. 5. Department of Epidemiology and Biostatistics, School of Public Health, State University of New York, Albany, USA.
Abstract
BACKGROUND: Although it is the general consensus that sarcoidosis patients who present with sarcoidosis-related symptoms have a worse outcome than patients whose disease is detected incidentally without symptoms, this premise has not been rigorously examined. METHODS: Consecutive patients followed longitudinally at one US university sarcoidosis clinic were questioned concerning the onset and description of sarcoidosis-related symptoms at disease presentation. The patients were classified into those with no sarcoidosis-related symptoms at presentation (NSP group) and those with symptoms at presentation (SP group). The following outcomes were examined in the NSP and SP groups: most recent spirometry, organ involvement, need for sarcoidosis therapy, most recent health related quality of life (HRQOL) as measured by the Sarcoidosis Assessment Tool (SAT), most recent chest imaging Scadding stage results. RESULTS: 660 sarcoidosis patients were analyzed, with 175 in the NSP group and 485 in the SP group. Compared to the NSP group, the SP group had a more frequent requirement for any sarcoidosis treatment, corticosteroid treatment, and non-corticosteroid treatment at some time and within the most recent year of follow up (at least 50% more than the NP group with strong statistical differences with p values all 0.01 or less). In addition, the SP group had significantly more organ involvement (p < 0.001) and several worse SAT domains (p < 0.022) than the NP group. There were no differences between the groups in terms of final spirometry or development of Scadding stage 4 chest radiographs. These findings held even after adjusting for age, sex, race, and time between presentation and the most recent follow-up visit using a multivariable logistic regression framework. CONCLUSIONS: In our sarcoidosis cohort, compared to the absence of symptoms at presentation, the presence of symptoms was associated with a greater need for treatment, more organ involvement, and worse HRQOL.
BACKGROUND: Although it is the general consensus that sarcoidosispatients who present with sarcoidosis-related symptoms have a worse outcome than patients whose disease is detected incidentally without symptoms, this premise has not been rigorously examined. METHODS: Consecutive patients followed longitudinally at one US university sarcoidosis clinic were questioned concerning the onset and description of sarcoidosis-related symptoms at disease presentation. The patients were classified into those with no sarcoidosis-related symptoms at presentation (NSP group) and those with symptoms at presentation (SP group). The following outcomes were examined in the NSP and SP groups: most recent spirometry, organ involvement, need for sarcoidosis therapy, most recent health related quality of life (HRQOL) as measured by the Sarcoidosis Assessment Tool (SAT), most recent chest imaging Scadding stage results. RESULTS: 660 sarcoidosispatients were analyzed, with 175 in the NSP group and 485 in the SP group. Compared to the NSP group, the SP group had a more frequent requirement for any sarcoidosis treatment, corticosteroid treatment, and non-corticosteroid treatment at some time and within the most recent year of follow up (at least 50% more than the NP group with strong statistical differences with p values all 0.01 or less). In addition, the SP group had significantly more organ involvement (p < 0.001) and several worse SAT domains (p < 0.022) than the NP group. There were no differences between the groups in terms of final spirometry or development of Scadding stage 4 chest radiographs. These findings held even after adjusting for age, sex, race, and time between presentation and the most recent follow-up visit using a multivariable logistic regression framework. CONCLUSIONS: In our sarcoidosis cohort, compared to the absence of symptoms at presentation, the presence of symptoms was associated with a greater need for treatment, more organ involvement, and worse HRQOL.
Authors: Hok Sreng Te; David M Perlman; Chetan Shenoy; Daniel J Steinberger; Rebecca J Cogswell; Henri Roukoz; Erik J Peterson; Lin Zhang; Tadashi L Allen; Maneesh Bhargava Journal: BMC Pulm Med Date: 2020-06-01 Impact factor: 3.317