Sarcoidosis: An Update for the Primary Care Physician

Oluranti A. Aladesanmi, MD, MPH

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In This Article

Racial and Ethnic Disparities

Racial differences in the clinical manifestations and course of sarcoidosis are well documented; however, there is no specific association between mortality and ethnicity.[10] Black patients are more likely to have extrapulmonary symptoms; constitutional symptoms; severe musculoskeletal symptoms; uveitis, hepatic, bone marrow, or extrathoracic lymph node involvement; lupus pernio; and cystic bone lesions. Their clinical course is more likely to be chronic and progressive, with a worse prognosis.

White patients are more likely to have asymptomatic disease, limited intrathoracic disease, and erythema nodosum, while Japanese patients have a higher prevalence of cardiac and ocular sarcoidosis. Lupus pernio is more common in Puerto Rican and black patients.

Geographic, ethnic, and genetic determinants play a role in these varied clinical manifestations. A 5-fold increase in familial relative risk was demonstrated using a multivariate mode in the ACCESS study,[11] which is consistent with previous evidence of familial clustering.

White individuals had a markedly higher familial relative risk compared with African American individuals, and differential effects of specific alleles on sarcoidosis susceptibility and progression in African American individuals have been identified.[12]

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