Sarcoidosis: An Update for the Primary Care Physician

Oluranti A. Aladesanmi, MD, MPH

In This Article

The ACCESS Study

The ACCESS study,[2] a case-controlled, multicenter study, involved 10 centers in the United States between 1997 and 1999. Incident cases and matched controls were compared on the prevalence of various exposures. Cases were confirmed by tissue diagnosis, compatible clinical course, and exclusion of other possible causes of granulomas. There probably was an overrepresentation of pulmonary disease because the principal investigators were pulmonologists; and since the study involved incident cases over a 2-year period, another limitation was the absence of chronic sarcoidosis patients, who are likely to have more severe disease.

The study examined the etiology, demographics, and clinical course of sarcoidosis patients. A total of 736 patients were enrolled, 63.6% female, 36.4% male, 53.4% white, and 44.2% black. The peak age and sex affected were females aged 35-39 years. Lung involvement was seen in 95% of patients, skin involvement other than erythema nodosum in 16%, extrathoracic lymph node involvement in 15%, eye involvement in 11.8%, and liver involvement in 11.5%.

Women were more likely to have eye involvement, erythema nodosum, and neurologic involvement, while men were more likely to have hypercalcemia. African American patients were more likely to have extrathoracic lymph node involvement and skin involvement other than erythema nodosum.

Some of the characteristics of lung involvement in patients enrolled in the study include the fact that 8% of patients in the study had Stage 0, 40% Stage 1, 36% Stage 2, 10% Stage 3, and 5% Stage 4 Scadding chest x-ray findings; 85% of patients had a forced expiratory volume in 1 second (FEV1)/forced vital capacity (FVC) of 70% or more; while almost 50% had Grade 0 dyspnea (ie, only with strenuous exercise). The authors found organ involvement differed by race, age, and sex, with race being the major determinant, and suggested future etiologic and therapeutic studies are mindful of this.


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