[The treatment, course and prognosis of sarcoidosis cases]

Sarcoidosis is a disorder with a highly variable prognosis. Although spontaneous cure is common, a small number of patients become progressively worse. In this study, we analysed 433 patients with sarcoidosis who presented to our institute. Twenty-seven patients (6.2%) of them developed serious morbidity. We studied the clinical course, prognosis and use of steroid therapy in those 27 patients. Eight (29.6%) of the 27 patients developed severe disability during their clinical course, in spite of their mild clinical symptoms and findings at first presentation. Therefore, clinical symptoms and findings, such as ocular disorders, ECG abnormalities, negative reaction to PPD, serum ACE values and lymphocyte count are not always useful markers for the prognosis of sarcoidosis. The relationship between maximum serum ACE values during the course and the duration of the active phase was investigated in 93 patients who were followed throughout their course of the disease. Improvement occurred more often within 5 years in the patients with DR5(+) HLA class II or DRw53(-) compared to patients with DR5(-) or DRw53(+). Using various combinations of specific antigens, the following 5 groups revealed good prognoses, frequently improving within 5 years, 1) DR5(+) and DR4(-), 2) DR5(+) and DRw53(-), 3) DR5(+), DR4(-) and DR8(-), 4) DR5(+), DR4(-) and DR9(-), 5) DR5(+), DR4(-), DR8(-) and DR9(-). HLA class II antigens may also play an important role in the prognosis of sarcoidosis. Since relapses almost always occurred after cessation of steroid therapy, the duration of treatment should be as long as possible and the dosage should also be tapered carefully.