Sarcoidosis: a journey through 50 years

Area of Science:

• Pulmonology
• Immunology
• Internal Medicine

Background:

• Sarcoidosis presents with diverse clinical manifestations globally.
• Previous research indicates variations in sarcoidosis presentation among different ethnic groups.
• Understanding regional variations is crucial for accurate diagnosis and effective management.

Purpose of the Study:

• To characterize the distinct clinical pattern and presentation of sarcoidosis in Eastern India.
• To compare the clinical course and prognosis of sarcoidosis in Eastern India with other populations.
• To evaluate an alternative treatment strategy for sarcoidosis in this region.

Main Methods:

• Biopsy-proven diagnosis of 200 sarcoidosis cases over three decades in Eastern India.
• Clinical data collection including symptoms, physical examination, laboratory tests (ESR, hypergammaglobulinaemia, hypercalciuria, SACE), and imaging (chest radiograph, 67-gallium scan).
• Analysis of clinico-radiological dissociation and comparison with international sarcoidosis cohorts.

Main Results:

• Eastern Indian sarcoidosis predominantly affects males over 40 from professional backgrounds.
• Common symptoms include constitutional (fever, malaise, weight loss) and respiratory issues.
• Significant findings include hepatosplenomegaly, lymphadenopathy, elevated ESR, hypergammaglobulinaemia, hypercalciuria, and raised SACE.
• High prevalence of clinico-radiological dissociation (81%) was observed.
• The clinical course and prognosis differ notably from Caucasian, Afro-American, Bantu, and Japanese patients.

Conclusions:

• Sarcoidosis in Eastern India exhibits a distinct demographic and clinical profile.
• The observed differences necessitate region-specific diagnostic and management approaches.
• An alternative treatment regimen excluding oral prednisolone proved effective, suggesting a potential therapeutic modification for this population.