[Modern criteria of sarcoidosis activity and approaches to glucocorticoid therapy]

Altogether 190 sarcoidosis patients were investigated including cytology of bronchoalveolar rinses in 31 patients, lung scintigraphy with 67Ga in 48, determination of the blood angiotensin converting enzyme activity in 18, and daily calciuria in 100 patients; 50 patients had erythema nodosum which turned out to be one of the main clinical symptoms of sarcoidosis activity. Corticosteroid therapy in patients with erythema nodosum was performed only in the presence of pulmonary changes and/or changes of the other internal organs. Extrathoracic manifestations (liver, splenic, renal, cardiac, CNS lesions) observed in 34 patients, deteriorated prognosis. Prolonged corticosteroid therapy was necessitated in all the cases; 4 patients were operated upon (splenectomy, nephrectomy, implantation of an artificial pacemaker); 3 patients died suddenly or from uremia. Comparison of the results of instrumental and laboratory methods showed that an increase in the lymphocyte count in bronchoalveolar rinses (by greater than 28%), total T-lymphocytes and T-active cells, 67Ga accumulation in the lungs, raised blood angiotensin converting enzyme activity, and hypercalciuria over 300 mg/day could be used as criteria of alveolitis activity in sarcoidosis. Corticosteroid therapy should be performed in stage II patients with the above symptoms only.