Review articleSarcoidosis: benefits of a multidisciplinary approach
Introduction
Sarcoidosis is a disseminated, granulomatous disease of unknown etiology that occurs throughout the world. Various infectious, organic, and anorganic agents are considered to cause a granulomatous reaction in susceptible hosts [1], [2]. Some genetic factors alter expression of the disease. Estimates of prevalence range from 1 to 40 per 100,000 individuals, varying among ethnic and racial groups [1]. The clinical course of sarcoidosis is highly variable, and virtually every organ can be involved. The lungs are affected in over 90% of patients with sarcoidosis [1]. It also frequently affects the lymph nodes, skin, and eyes. Notably, the clinical presentation of sarcoidosis is highly variable and the course of the disease is unpredictable. Spontaneous recovery may occur, but the disease can also become chronic and progressive, estimated in up to 25% of the cases. Overall, mortality from sarcoidosis is 1–5%. To date, it is the second most common respiratory disease in young adults after asthma. In addition, many sarcoidosis patients report non-specific symptoms such as fatigue and pain [1], [3], [4], [5], [6], [7], [8], [9]. These non-specific symptoms are disabling for the patient, cause an impaired quality of life [9], [10], [11], [12], [13], and may become chronic. Especially for patients with chronic sarcoidosis, proper management of their disease is important. In several other disorders such as sleep apnea syndrome, in trauma patients, and in patients with severe functional deficits, early initiation of multidisciplinary treatment appears to be promising and encouraging. In the present paper, the benefits of a multidisciplinary approach for both patients and physicians are discussed.
Section snippets
Diagnostic work-up
The management of sarcoidosis is generally coordinated by a pulmonary physician. However, sarcoidosis can involve any organ. Sarcoidosis patients not only suffer from symptoms related to the lungs (e.g. cough, breathlessness), but they may also suffer from a wide spectrum of other symptoms [1], [3]. These symptoms include persistent fatigue, arthralgias, muscle pain, weight loss, skin lesions, eye problems, and neurological as well as cardiological problems [1], [3], [9]. In our experience [4],
Patient care
During the past few years, there has been an increase in the number of requests for second opinions by chronic sarcoidosis patients from all over The Netherlands who have come to the outpatient clinic of the University Hospital in Maastricht. To be eligible for a second opinion, patients had to have been referred by their specialist or general practitioner. To improve the management of this chronic patient population and to better meet the increasing demand for these second opinions, a
Acknowledgments
The author would like to express her thanks to all of the dedicated participants in the Sarcoidosis Management Center. Without their efforts, enthusiasm, and help, this approach would not be possible.
References (26)
- et al.
Clinical presentation of sarcoidosis in the Netherlands. An epidemiological study
Neth J Med
(1998) - et al.
Computer program supporting the diagnostic accuracy of cellular BALF analysis: a new release
Respir Med
(2001) - et al.
Early treatment of stage II sarcoidosis improves 5-year pulmonary function
Chest
(2002) - et al.
Thalidomide for chronic sarcoidosis
Chest
(2002) - et al.
Association of man-made mineral fibre exposure and sarcoid like granulomas
Respir Med
(2000) - et al.
Small fiber neuropathy in sarcoidosis
Lancet
(2002) - et al.
Statement on Sarcoidosis
Sarcoidosis Vasc Diffuse Lung Dis
(1999) - et al.
Sarcoidosis: genes and microbes—soil or seed?
Sarcoidosis Vasc Diffuse Lung Dis
(2001) Complications of sarcoidosis. Chronic fatigue syndrome
Sarcoidosis
(1993)Dysphoria and sarcoidosis
Sarcoidosis Vasc Diffuse Lung Dis
(1998)
Association of fatigue with an acute phase response in sarcoidosis
Eur Respir J
Fatigue and sarcoidosis
Eur Respir J
Fatigue associated with obstructive sleep apnea in a patient with sarcoidosis
Respiration
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