Seminars in respiratory infections
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Epidemiological knowledge of sarcoidosis is based mainly on studies performed more than 30 years ago. These early case-control studies produced some interesting risk factor-disease associations, but a clear causative mechanism in sarcoidosis remains unknown. Studies in military and veteran populations showed a clear preponderance of sarcoidosis in African Americans compared with Caucasians. ⋯ We have found that familial sarcoidosis is almost three times more common in African-American (17%) than Caucasian cases (6%). Future genetic studies can benefit from the extensive catalog of candidate genes that is emerging from the human genome project. The epidemiological evidence to date strongly suggests that studies seeking causes for sarcoidosis need to consider both environmental and genetic risk factors to be successful because the two likely interact with each other to produce disease.
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Treatment of sarcoidosis is controversial. The clinical expression and natural history of sarcoidosis is variable, and spontaneous remissions occur in up to 60% of patients. ⋯ Toxicities associated with therapy may be substantial, particularly when high dosages are used. We review the pharmacologic agents used to treat sarcoidosis, toxicities associated with treatment, and appropriate use and monitoring of these therapeutic modalities.
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Semin Respir Infect · Sep 1998
ReviewInvolvement of T cells and alterations in T cell receptors in sarcoidosis.
Sarcoidosis is recognized to be a multisystem granulomatous disease characterized by activated, cytokine-producing T cells and macrophages at sites of inflammation. The purpose of this article is to review new evidence concerning the role of T cells in sarcoidosis. ⋯ In addition, data on cytokine production in sarcoidosis indicate that tissue inflammation is dominated by expression of type 1 (T helper 1) cytokines such as interferon-gamma and interleukin-12 that, in keeping with experimental models of granulomatous diseases, likely orchestrate the granulomatous response. These studies offer new insight into the molecular mechanisms of granuloma formation in sarcoidosis and provide a framework for developing new therapeutic strategies for the treatment of this disease.