Caracterización clínica y evolución de pacientes con sarcoidosis en dos instituciones en Medellín, Colombia, 2006-2020. Análisis basal y de seguimiento de una cohorte retrospectiva

Abstract

Introduction: Sarcoidosis is an inflammatory systemic disorder characterized by the formation of noncaseating granulomas in different organs of the body, mainly compromising the lungs and skin. The principal manifestations are hilar adenopathy and panniculitis. The treatment depends on the clinical presentation and the severity. There are very few reports of the clinical characteristics of the disease in underdeveloped countries such as Colombia. Aim: To describe the clinical and socio-demographic characteristics of a cohort of patients with sarcoidosis in two highcomplexity institutions. Methods: Retrospective chart review of adult patients with confirmed diagnosis of sarcoidosis, who were treated at Clínica Universitaria Bolivariana and Clínica CardioVID in Medellín, Colombia, from January 2006 to December 2020. Results: Fifty-two patients were included; 34 (65.4 %) were women. The most common approach for definitive diagnosis was tissue biopsy (n=43; 82.7 %). Most frequent organ involvement included lungs (n=44; 84.6 %), skin (n=16; 30.8 %), cardiac (n=5; 9.6 %), and neurologic (n=2; 3.8 %). 80.7 % of the subjects received some form of treatment. In the follow-up, 11 patients (37.9 %) persisted with the initial organ involvement. Conclusions: This pathology shows similar clinical features compared to other reports in the literature, with more cases of cardiac involvement. Steroids continue to be the mainstem of treatment for this disease, and the predominating diagnosis is histologic.

Keywords:

sarcoidosis

sarcoidosis pulmonar

epidemiología

enfermedades pulmonares

sarcoidosis

pulmonary sarcoidosis

epidemiology

lung diseases

References

1. Grunewald J, Grutters JC, Arkema EV, Saketkoo LA, Moller DR, Müller-Quernheim J. Sarcoidosis. Nat Rev Dis Primer. 4 de julio de 2019; 5(1):1-22.

2. Rissmiller R, James WE. Sarcoidosis: The Organs Involved. A Primer for Primary Care Physicians. Int Arch Intern Med [Internet]. 31 de diciembre de 2017 [citado 19 de diciembre de 2021]; 1(1). Disponible en: https://clinmedjournals.org/articles/iaim/international-archives-of-internal-medicineiaim-1-002.php?jid=iaim

3. Brito-Zerón P, Kostov B, Superville D, Baughman RP, Ramos-Casals M, Autoimmune Big Data Study Group. Geoepidemiological big data approach to sarcoidosis: geographical and ethnic determinants. Clin Exp Rheumatol. diciembre de 2019; 37(6):1052-64.

4. Montoya-Castillo M, Herrera-Uribe S, Berlinghieri-Pérez JD, Montoya-Castillo M, Herrera-Uribe S, Berlinghieri-Pérez JD. Löfgren syndrome as an acute presentation of sarcoidoisis. Rev Colomb Reumatol. junio de 2018; 25(2):126-31.

5. Mahajan VK, Sharma NL, Sharma RC, Sharma VC. Cutaneous sarcoidosis: clinical profile of 23 Indian patients. Indian J Dermatol Venereol Leprol. febrero de 2007; 73(1):16-21.

6. Alcoba Leza M, Pérez-Simón MR, Guerra Laso JM, Carro Fernández JA, Alonso Fernández MA, Blanco Iglesias B, et al. Sarcoidosis en el área sanitaria de León: Epidemiología y clínica. An Med Interna. diciembre de 2003; 20(12):21-4.

7. Silva LCC da, Hertz FT, Cruz DB, Caraver F, Fernandes JC, Fortuna FP, et al. Sarcoidose no sul do Brasil: estudo de 92 pacientes. J Bras Pneumol. octubre de 2005; 31(5):398-406.

8. Costabel U, Hunninghake GW. ATS/ERS/WASOG statement on sarcoidosis. Sarcoidosis Statement Committee. American Thoracic Society. European Respiratory Society. World Association for Sarcoidosis and Other Granulomatous Disorders. Eur Respir J. 1 de octubre de 1999; 14(4):735-7.

9. Zapata-González F, Vásquez-Ochoa LA, Arroyave-Sierra JE, Arredondo-Ossa MI, Molina-Vélez V, Del Río-Cobaleda DY. Sarcoidosis cutánea. Rev CES Med. julio de 2014; 28(2):293-306.

10. Torquato MF, Costa MKS da, Nico MMS. Cutaneous sarcoidosis: clinico–epidemiological profile of 72 patients at a tertiary hospital in São Paulo, Brazil. An Bras Dermatol. 1 de enero de 2020; 95(1):57-62.

11. Lopes MC, Amadeu TP, Ribeiro-Alves M, da Costa CH, Silva BRA, Rodrigues LS, et al. Defining prognosis in sarcoidosis. Medicine (Baltimore). 25 de noviembre de 2020; 99(48):e23100.

12. Awada H, Abi-Karam G, Fayad F. Musculoskeletal and other extrapulmonary disorders in sarcoidosis. Best Pract Res Clin Rheumatol. Diciembre de 2003; 17(6):971-87.

13. Soto-Gomez N, Peters JI, Nambiar AM. Diagnosis and Management of Sarcoidosis. Am Fam Physician. 15 de mayo de 2016; 93 (10):840-8.

14. Valeyre D, Jeny F, Rotenberg C, Bouvry D, Uzunhan Y, Sève P, et al. How to Tackle the Diagnosis and Treatment in the Diverse Scenarios of Extrapulmonary Sarcoidosis. Adv Ther. 2021; 38(9):4605-27.

15. Chavarriaga-Restrepo A, López-Amaya JE, Mesa-Navas MA, Velásquez-Franco CJ. Sarcoidosis: many faces, one disease. Narrative review of the literature. Iatreia. 32(3):191-203.

16. Muñoz C, Restrepo-Escobar M, Martínez-Muñoz M, Echeverri A, Márquez J, Pinto LF. Differences between patients with sarcoidosis with and without joint involvement treated for fifteen years in a third level hospital. Reumatol Clin. febrero de 2020; 16(1):45-8.

17. Bautista-Vargas M, Puerta G, Scarpetta-González DF, Marín JD, Salazar-Otoya N, Nieto-Aristizábal I, et al. Epidemiological characterization of patients with sarcoidosis in a high complexity hospital in southwestern Colombia. Rev Colomb Reumatol. 2 de junio de 2021.

18. Santamaria-Alza Y, Fajardo Rivero JE. Sarcoidosis: una serie de casos del nororiente colombiano. Neumol Cir Torax. 76(1):14-6.

19. Magpi [Internet]. Disponible en: https://www.magpi.com

20. Microsoft Excel [Internet]. Microsoft office; Disponible en: https://www.microsoft.com/en-us/microsoft-365/excel

21. IBM Corp. Released 2019. IBM SPSS Statistics for Windows, Version 26.0. Armonk, NY: IBM Corp.

22. Valovis R. Sarcoidosis: Estudio clínico de 51 casos y revisión de la literatura. Acta Med Colomb. 1977; 2(2):101-10.

23. Yee AMF. Sarcoidosis: Rheumatology perspective. Best Pract Res Clin Rheumatol. abril de 2016; 30(2):334-56.

24. Iannuzzi MC, Rybicki BA, Teirstein AS. Sarcoidosis. N Engl J Med. 22 de noviembre de 2007; 357(21):2153-65.

25. Hosoda Y, Yamaguchi M, Hiraga Y. Global epidemiology of sarcoidosis: What story do prevalence and incidence tell us? Clin Chest Med. diciembre de 1997; 18(4):681-94.

26. Fernández-Ramón R, Gaitán-Valdizán JJ, Sánchez-Bilbao L, Martín-Varillas JL, Martínez-López D, Demetrio-Pablo R, et al. Epidemiology of sarcoidosis in northern Spain, 1999-2019: A populationbased study. Eur J Intern Med. 1 de septiembre de 2021; 91:63-9.

27. Tamada T, Nara M, Murakami K, Gamo S, Aritake H, Shimizu M, et al. The Clinical Features of Patients with Sarcoidosis and Malignant Diseases in Japan. Intern Med. 15 de enero de 2021; 60(2):209-16.

28. Sweiss NJ, Korsten P, Baughman RP. Sarcoidosis. En: Kelley y Firestein Tratado de reumatología. 10.a ed. Barcelona: Elsevier; 2018. p. 1983-96.

29. Amaral M. Sarcoidosis pulmonar: actualización y reporte de casos. Rev Urug Med Interna. 2016; 118-31.

30. Yépez R, Malagón C, Olmos C. Sarcoidosis en pediatría: reporte de 7 casos. Rev Colomb Reumatol. abril de 2013; 20(2):102-10.

31. Trivieri MG, Spagnolo P, Birnie D, Liu P, Drake W, Kovacic JC, et al. Challenges in Cardiac and Pulmonary Sarcoidosis: A JACC State-of-the-Art Review. J Am Coll Cardiol. 20 de octubre de 2020; 76(16):1878-901.

32. Govender P, Berman JS. The Diagnosis of Sarcoidosis. Clin Chest Med. diciembre de 2015; 36(4):585-602.

33. Ungprasert P, Crowson CS, Matteson EL. Characteristics and Long-Term Outcome of Neurosarcoidosis:A Population-Based Study from 1976-2013. Neuroepidemiology. 2017; 48(3-4):87-94.

34. De Ridder J, Ronsmans S, Vanderschueren S, Wuyts W, Yserbyt J. Clinical characteristics of sarcoidosis patients in Belgium. Acta Clin Belg. 16 de septiembre de 2020; 0(0):1-8.

35. Ghanizada M, Rossing K, Bundgaard H, Gustafsson F. Clinical presentation, management and prognosis of patients with cardiac sarcoidosis. Dan Med J. abril de 2018;65(4):A5462.

36. Alnaimat F, Al Oweidat K, Alrwashdeh A, Alnashrati A, Barham S, Hijaz M, et al. Sarcoidosis in Jordan: A Study of the Clinical Phenotype and Disease Outcome. Arch Rheumatol. 7 de febrero de 2020; 35(2):226-38.

37. Nordenswan H, Lehtonen J, Ekström K, Räisänen Sokolowski A, Mäyränpää MI, Vihinen T, et al. Manifestations and Outcome of Cardiac Sarcoidosis and Idiopathic Giant Cell Myocarditis by 25 Year Nationwide Cohorts. J Am Heart Assoc. 16 de marzo de 2021; 10(6):e019415.

38. Fussner LA, Karlstedt E, Hodge DO, Fine NM, Kalra S, Carmona EM, et al. Management and outcomes of cardiac sarcoidosis: a 20-year experience in two tertiary care centres. Eur J Heart Fail. 2018; 20(12):1713-20.

39. Chamorro-Pareja N, Marin-Acevedo JA, Chirilă RM. Cardiac sarcoidosis: Case presentation and Review of the literature. Romanian J Intern Med Rev Roum Med Interne. 1 de marzo de 2019; 57(1):7-13.

40. Mehta D, Lubitz SA, Frankel Z, Wisnivesky JP, Einstein AJ, Goldman M, et al. Cardiac Involvement in Patients with Sarcoidosis: Diagnostic and Prognostic Value of Outpatient Testing. CHEST. 1 de junio de 2008; 133(6):1426-35.

41. West SG. Current management of sarcoidosis I: pulmonary, cardiac, and neurologic manifestations. Curr Opin Rheumatol. mayo de 2018; 30(3):243-8.

42. Gupta R, Baughman RP. Advanced Pulmonary Sarcoidosis. Semin Respir Crit Care Med. octubre de 2020; 41(5):700-15.

43. Hospital Universitario San Vicente Fundación, Muñoz-Ortiz E, Arévalo-Guerrero E, Hospital Universitario San Vicente Fundación, Abad P, Fundación Instituto de Alta Tecnología Médica (IATM), et al. Sarcoidosis cardíaca. Estado del arte. IATREIA [Internet]. octubre de 2016 [citado 17 de diciembre de 2021]; 29(4). Disponible en: https://revistas.udea.edu.co/index.php/iatreia/article/view/25524

44. Matsui K, Adachi M, Kawasaki Y, Matsuda K, Shinohara K. Sarcoidosis Acutely Involving the Musculoskeletal System. Intern Med. 2007; 46(17):1471-4.

45. Chatham W. Rheumatic manifestations of systemic disease: sarcoidosis. Curr Opin Rheumatol. enero de 2010; 22(1):85-90.

46. Nessrine A, Zahra AF, Taoufik H. Musculoskeletal involvement in sarcoidosis. J Bras Pneumol. abril de 2014; 40:175-82.