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Eur Respir Rev. 2016 Jun;25(140):141-50. doi: 10.1183/16000617.0013-2016.

Management of sarcoidosis in clinical practice.

Author information

1
AP-HP, Pulmonary Dept, Avicenne University Hospital, Bobigny, France University Paris 13, COMUE Sorbonne Paris Cité, Bobigny, France.
2
AP-HP, Pulmonary Dept, Avicenne University Hospital, Bobigny, France.
3
AP-HP, Nuclear Medicine Dept, Avicenne University Hospital, Bobigny, France.
4
AP-HP, Radiological Dept, Avicenne University Hospital, Bobigny, France.
5
University Paris 13, COMUE Sorbonne Paris Cité, Bobigny, France AP-HP, Physiological Dept, Avicenne University Hospital, Bobigny, France.
6
AP-HP, Pulmonary Dept, Avicenne University Hospital, Bobigny, France University Paris 13, COMUE Sorbonne Paris Cité, Bobigny, France dominique.valeyre@aphp.fr.

Abstract

Sarcoidosis is a systemic disease of unknown cause with very diverse presentation, outcome, severity and need for treatments. While some presentations may be very typical, for many patients, the presentation is nonspecific, with shared associations with other diseases at times being by far more frequent or misleading, which can be a cause of significant delay and often several consultations before a diagnosis of sarcoidosis can be confirmed. This is particularly the case when pulmonary manifestations are in the forefront. The diagnosis relies on three well-known criteria. In clinical practice, these criteria are not easily implemented, particularly by physicians without expertise in sarcoidosis, which can lead to a risk of either under- or over-diagnosis. Qualifying the presentation according to sarcoidosis diagnosis is essential. However, it is often not easy to classify the presentation as typical versus compatible or compatible versus inconsistent. Further investigations are needed before any other hypothesis is to be considered. It is important to detect events and to determine whether or not they are indicative of a flare of sarcoidosis. Eventually, treatment needs to be related to the correct indications. The evaluation of the efficacy and safety of treatments is crucial. To address such issues, we present five emblematic cases that illustrate this.

PMID:
27246591
DOI:
10.1183/16000617.0013-2016
[Indexed for MEDLINE]
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