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Why doesn't anyone want to cure sarcoidosis?: The neglect of disease termination

Published:November 24, 2022DOI:https://doi.org/10.1016/j.rmed.2022.107063
      Sarcoidosis frequently resolves. Resolution rates of sarcoidosis vary depending on the population that is studied. A Spanish sarcoidosis cohort of 193 patients reported that 160 (83%) achieved resolution [
      • Mana J.
      • Salazar A.
      • Manresa F.
      Clinical factors predicting persistence of activity in sarcoidosis: a multivariate analysis of 193 cases.
      ]. These authors and others [
      • Romer F.K.
      Presentation of sarcoidosis and outcome of pulmonary changes.
      ] have found that resolution of sarcoidosis usually occurs within the first two years after diagnosis, and resolution of active disease beyond two years only occurs 10% of the time. However, data from Japanese and Swedish sarcoidosis cohorts found increasing rates of chest radiograph resolution for five years, with few additional resolutions beyond that point [
      • Nagai S.
      • Shigematsu M.
      • Hamada K.
      • Izumi T.
      Clinical courses and prognoses of pulmonary sarcoidosis.
      ,
      • Hillerdal G.
      • Nou E.
      • Osterman K.
      • Schmekel B.
      Sarcoidosis: epidemiology and prognosis. A 15-year European study.
      ,
      • Pietinalho A.
      • Ohmichi M.
      • Lofroos A.B.
      • Hiraga Y.
      • Selroos O.
      The prognosis of pulmonary sarcoidosis in Finland and Hokkaido, Japan. A comparative five-year study of biopsy-proven cases.
      ]. The cumulative 5-year chest radiograph resolution rate was 60% and 80% in the Japanese and Swedish sarcoidosis cohorts respectively [
      • Nagai S.
      • Shigematsu M.
      • Hamada K.
      • Izumi T.
      Clinical courses and prognoses of pulmonary sarcoidosis.
      ,
      • Hillerdal G.
      • Nou E.
      • Osterman K.
      • Schmekel B.
      Sarcoidosis: epidemiology and prognosis. A 15-year European study.
      ,
      • Pietinalho A.
      • Ohmichi M.
      • Lofroos A.B.
      • Hiraga Y.
      • Selroos O.
      The prognosis of pulmonary sarcoidosis in Finland and Hokkaido, Japan. A comparative five-year study of biopsy-proven cases.
      ]. An analysis of 818 British sarcoidosis patients found that slightly more than half had resolution of disease within 2 years [
      • Neville E.
      • Walker A.N.
      • James D.G.
      Prognostic factors predicting the outcome of sarcoidosis: an analysis of 818 patients.
      ]. The World Association of Sarcoidosis and Other Granulomatous Disorders (WASOG) Task Force of 10 sarcoidosis referral centers found that one-quarter of their sarcoidosis patients did not require treatment for more than one year [
      • Baughman R.P.
      • Nagai S.
      • Balter M.
      • et al.
      Defining the clinical outcome status (COS) in sarcoidosis: results of WASOG Task Force.
      ]. Regardless of these differing resolution rates that were confounded by varying definitions of a sarcoidosis resolution, it is clear that a sizeable proportion of sarcoidosis patients experience termination of their disease.

      Keywords

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