Review article
Sarcoidosis: benefits of a multidisciplinary approach

https://doi.org/10.1016/S0953-6205(03)00076-1Get rights and content

Abstract

It is well established that sarcoidosis is a multisystem disorder of unknown cause(s). Practically no organ is immune to sarcoidosis. It subsides in most cases, but it may worsen and become chronic in others. Pulmonary problems may persist, but also devastating extrapulmonary complications may become apparent. Appropriate management of sarcoidosis is mandatory as it predominantly affects fairly young adults. This requires the attention of pulmonologists as well as specialists from other medical disciplines. Accordingly, when treating sarcoidosis patients, a multidisciplinary approach is recommended that focuses attention on somatic as well as psychosocial aspects of this erratic disorder. Specialists from all participating medical disciplines—including respiratory diseases—may benefit from a multidisciplinary approach and be stimulated to enhance their professional interest and knowledge of sarcoidosis. The benefit of such an approach should be explored in the near future.

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.

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