pulmonary disorders
Sarcoidosis
Prognosis for Sarcoidosis
Although spontaneous remission is common, disease manifestations and severity are highly variable, and many patients require corticosteroids to relieve symptoms or slow progressive organ function decline at some time during the disease course. Thus, serial monitoring for evidence of relapse is imperative. Almost two thirds of patients with sarcoidosis eventually achieve remission with few or no sequelae. In about 50% of patients who have spontaneous remission, remission occurs within the first 3 years after diagnosis. Fewer than 10% of these patients relapse after 2 years. Patients who do not experience remission within 2 to 3 years are likely to have chronic disease. Sarcoidosis is thought to be chronic in up to 30% of patients, and 10 to 20% experience permanent sequelae. The disease is fatal in 1 to 5% of patients, typically due to respiratory failure caused by pulmonary fibrosis, and less often due to pulmonary hemorrhage caused by aspergilloma. However, in Japan, infiltrative cardiomyopathy causing arrhythmias and heart failure is the most common cause of death. Prognosis is worse for patients with extrapulmonary sarcoidosis and for Black people. Remission occurs in 89% of White patients and 76% of Black patients with no extrathoracic disease and in 70% of White patients and 46% of Black patients with extrathoracic disease. Good prognostic signsinclude Löfgren syndrome (triad of acute polyarthritis, erythema nodosum, and hilar adenopathy) Poor prognostic signsinclude Chronic uveitis Lupus pernio Chronic hypercalcemia Neurosarcoidosis Cardiac involvement Extensive pulmonary involvement and/or development of pulmonary hypertension Little difference is demonstrable in long-term outcome between treated and untreated patients, and relapse is common when treatment ends. 