Talk:Sarcoidosis

message: hi,  my husband, 51 yrs., recently diagnosed with sarcoid.  the involvement in the bones and marrow is such that the current doctor says he has "poor prognosis factors" due to the extenrt of the diasease and that she thinks he is "doing quite well for the shape he is in".  she also mentioned mayo clinic due to the extreme involvement in the lungs, spinal column etc.  he works outside on road construction..... she has perscribed 80 mg prednisone for 1 wl, then 70 2nd week then 60 for the remainder of a six month period plus bactrim, plus calcium, vit d and fosomax.....  no one will say what the "poor prognosis factor" is.  i have a call in to see if the dr thinks we whould go to mayo......  is there any medical person out there that can help us?????  where should i write so someone can look at his test results etc....  he recentl;y had a kidney stone rem,oved... that is what started all this the er dr said he had cancer!!!  we have been to like 8 different Drs. getting this diagnosis - bone marrow biopsy beint the last one because there is so much involvement in the spine they were afraid to call it sarc
thanks, Deb......
dshupak@msn.com —Preceding unsigned comment added by 71.210.86.109 (talk) 19:17, 7 June 2006
:Good day, Deb. I wish to point you towards Wikipedia:Medical disclaimer. While many Wikipedia writers are experts in their subject area, this is a publicly editable encyclopedia. As such, I recommend you discuss your husband's decision with a licensed medical doctor -- any person could post fictitious responses to you, and the information would be unreliable. I wish you and your husband the best. —Preceding unsigned comment added by 74.128.192.127 (talk) 20:28, 5 November 2006
::Hello Deb, 
::I am not a medical professional but i've been dealing with Sarcoidosis for 10 years and worked in a Hospital for almost that long. I see 3 main issues to address in your article. 
::First, Mayo Clinic and The Cleveland Clinic Foundation are 2 of the best hospitals for treatment of Sarcoidosis and if there is a question a second opinion from a more qualified specialist is a good thing. Best to err on the side of caution. 
::Second, He is on what is called a taper down burst dose of prednisone. This is typical for controlling a Sarcoid flareup. Unfortunately the prednisone itself will tend to mask the symptoms so you will not really get a better idea of how he's really doing until he's on the lower doses. 
::Third, You mentioned Vitamin D as part of his treatment. That is to be expected with the involvement in the bones but Vitamin D in Sarcoidosis patients has been known to cause Hypercalcemia due to indications of false lows in patients with Sarcoidosis so his care should be supervised by a qualified physician. If you want to do some research on your own or get better input I would strongly urge you to sign up at Inspire.com most of us there have been dealing with this disease anywhere from 1 to 30 years and can give you very good input but remember there is no substitute for a qualified medical specialist. ( I did say specialist not physician) Good luck to you both.  —Preceding unsigned comment added by 174.100.135.1 (talk) 03:56, 23 October 2010 (UTC)
thread_title:  sarcoidosis 

message: Can we add a layman's description to the first paragraph?  I want to know what sarcoidosis is, but I don't know what a non-necrotising granuloma is.  Also, shouldn't the cause be in the first paragraph as well?  --65.91.102.204 16:26, 20 March 2007 (UTC)
replies: text: I agree. We should add a Related Terms section that includes the definition of some of these medical terms. Otherwise we should review the article and create hyperlinks to the definition where these terms are used. 69.109.246.218 (talk) 18:05, 9 August 2008 (UTC)
thread_title:  Suggestions for the first paragraph 

message: Review in NEJM (Tierstein worked with Siltzbach of Kveim test fame) JFW | T@lk 01:52, 29 November 2007 (UTC)
thread_title:  NEJM 

message: I changed the wording in reference to the link between sarcoidosis and the WTC collapse. The page it references lists 2 cases that were "attributed" to dust inhalation, but from what I read in the citations not actually caused by the dust. The NY Times article states that the dust most likely impacted the time of death, but that the disease was present prior. I'm open to discussion and either making it an even lighter reference, or reverting if there is other evidence. Schu1321 (talk) 08:21, 29 May 2008 (UTC)
thread_title:  Sept 11/WTC references 

message: I have created this section again, imho this deserves to have an own section or at least a place outside the Causes and pathophysiology section because the latter is too much speculative - and can expected to be as long as there is no definitive answer about the causes.  Richiez (talk) 12:54, 11 June 2008 (UTC)
thread_title:  Pregnancy 

message: Shouldn't there be a section discussing the differences between Sarcoidosis and HIV? When I first heard of this disease I wondered if doctors could mistake HIV for Sarcoidosis - in the situation where there was a rushed diagnosis. However, once I read about the circumstances under which Sarcoidosis thrives, it became clear to me these were diseases at 180 degress of each other:
http://www.thebody.com/Forums/AIDS/Infections/Archive/Miscellaneous/Q14878.html
It is possible that your sracoidosis may flare when your T cells are high (meaning your immunesystem is working better) and your viral load is not detectable. This is because the manifestations of sarcoidosis depend on a functioning immune system for expression. So as you continue to do well with your HIV, you may well need active oversight by a knowledgeable doctor for your sarcoidosis. With your current HIV status, it is highly unlikely that any clinical problem will be directly related to your HIV, so you should relax on that score.
69.109.246.218 (talk) 17:54, 9 August 2008 (UTC)
replies: text: I would think it would be great see a page titled "The Great Mimicker" which could discuss the similarities of sarcoidosis with many of the diseases it emulates. - 7 July 2010  —Preceding unsigned comment added by 76.25.74.193 (talk) 23:47, 28 July 2010 (UTC)
thread_title:  Shouldn't There Be A Section Discussing The Difference Between Sarcoidosis and HIV? 

message: Should the quote be "As much as 70% of people do not require treatment..."  The quote as it stands now "Between 30 and 70%..." is odd because either you require treatment or you don't, so there should be a firm number like X % of people with this disease require treatment. 68.42.71.39 (talk) 23:21, 10 August 2008 (UTC)
replies: text: it is faithfully copied form the mentioned source.. I wonder if it would be ok to add  "(estimates do vary)" if the original source does not explicitly explain its meaning of 30-70%? Richiez (talk) 21:14, 20 September 2009 (UTC)
thread_title:  Treatment Section 

message: I think that an important contribution to this discussion is the Foundation for Sarcoidosis Research. The Foundation for Sarcoidosis Research (FSR) is the United States' leading nonprofit organization dedicated to improving care for sarcoidosis patients and to finding a cure for this disease. 
Foundation for Sarcoidosis Research
They are active across the United States and have a growing presence in many areas both in the medical community and the patient community.
— Preceding unsigned comment added by Ubritsa (talk • contribs) 02:42, 31 March 2009
: It is unclear how this would be useful for the reader. Not speaking about the organisation but their webpage. Richiez (talk) 11:46, 26 May 2010 (UTC)
thread_title:  External link 

message: The following language
"Chest X-ray changes are divided into four stages
* Stage 1 bihilar lymphadenopathy
* Stage 2 bihilar lymphadenopathy and reticulonodular infiltrates
* Stage 3 bilateral pulmonary infiltrates
* Stage 4 fibrocystic sarcoidosis typically with upward hilar retraction, cystic & bullous changes"
is in medical language that would be more easily understood by providing an image for each stage.  Perhaps the discussion should include CT images rather than or in addition to chest x-rays.  In any event, this should be a priority.  This would help a patient who is familiar with his or her own images to understand the severity of his or her disease.  —Preceding unsigned comment added by 71.79.245.47 (talk) 16:15, 21 February 2010 (UTC)
thread_title:  Images needed 

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replies: text: I've replaced the errant reference (#46) with two new ones supporting the co-occurrence of sarcoidosis with cancer. Martin (Smith609 – Talk) 12:35, 2 May 2010 (UTC)
thread_title:  Reference to broken DOI 

message: The first sentence describes it as a "systematic" disease.  I assume that should be "systemic"?  Systematic doesn't seem to make sense...  —Preceding unsigned comment added by 76.208.70.201 (talk) 00:36, 26 May 2010 (UTC)
replies: text: Agreed, although this appears to be fixed by now.  Rytyho usa (talk) 22:56, 27 March 2013 (UTC)
thread_title:  Systemic? 

message: Is Sarcoidosis not also known as Hutchinson's disease? Can anyone confirm this and make the edit? Perhaps there is a Wiki article on the man himself (Hutchinson)?  — Preceding unsigned comment added by 123.243.173.222 (talk) 16:52, 3 July 2011 (UTC)
replies: text: Possibly, but without a reliable source, we mustn't state as such. --Redrose64 (talk) 18:48, 3 July 2011 (UTC)
thread_title: Hutchinson's Disease

message: Are the figures given under Epidemiology actually prevalence rather than incidence, as no time period is given? DeCaux (talk) 12:32, 5 November 2012 (UTC)
thread_title: Incidence or Prevalence?

message: The image of lesions on the neck is somewhat vague as it looks a lot like plaque psoriasis (though the important detail here is that plaque psoriasis spreads to the face in the final stage of skin coverage, and rarely does anybody ever get to that). So a different picture depicting the sarcoidotal lesions as seen in Google Images would be more appropriate.  — Preceding unsigned comment added by Adifeldman (talk • contribs) 05:05, 5 April 2013 (UTC)
thread_title:  Current image 

message: Hello to all! I am proposing a merge from the following articles into the main sarcoidosis article:
* Annular sarcoidosis
* Erythrodermic sarcoidosis
* Ichthyosiform sarcoidosis
* Hypopigmented sarcoidosis
* Erythrodermic sarcoidosis
* Morpheaform sarcoidosis
* Mucosal sarcoidosis
* Papular sarcoid
* Scar sarcoid
* Subcutaneous sarcoidosis
* Ulcerative sarcoidosis
This is for the following reasons:
*These articles are very short in length (1-2 sentences) and have not been edited significantly in 3-4 years.
*This knowledge shouldn't be obscured from readers of sarcoidosis by virtue of being isolated in an obscure article of 1-2 lines.
*These topics may receive more attention by being mentioned in the main article.
*The articles, if needs be, could be re-expanded at a later date.
Kind Regards, LT90001 (talk) 13:01, 9 August 2013 (UTC)
thread_title:  Merge 

message: Particularly good on basic science. 
--Nbauman (talk) 07:17, 5 October 2013 (UTC)
thread_title:  Lancet review article, 2013 

message: Wikipedia, talk, Sarcoidosis
I found myself in disagreement with some of the content of the current article. I’ve supplied citations supporting the views I’ve expressed so that you can review them and come to a decision to either reject or accept the modifications I’ve indicated. If some articles are inconvenient to access, I may be able to supply them on request. I hope these suggested modifications will augment and improve the accuracy of the article. Yours truly,
Jerome M Reich, MD, FCCP
Reichje@isp.com
1.	General: There is no better overview of the subject than Scadding JG, Mitchell DN. Sarcoidosis 1985 University Press, Cambridge . Hutchinson’s contributions and citations can be found in this tome, e.g., Hutchinson J. Cases of Mortimer’s malady. Arch Surg, Lond. 1898;9:307-14.
2.	Prognosis: Pulmonary fibrosis is most often residual, localized and clinically inconsequential. (Reich JM, Johnson RE. Course and prognosis of sarcoidosis in a nonreferral setting: analysis of 86 patients observed for ten years. Am J Med 1985;78:61-67). Mortality (actually, cumulative sarcoidosis fatality) in referral settings after adjustment for stage (still, the best available prognostic indicator) is 7.5-fold that in community settings (<1%) (Reich JM. Mortality of intrathoracic sarcoidosis in referral vs. population-based settings: influence of stage, ethnicity, and corticosteroid therapy. Chest 2002;121:32-39.)
3.	Diagnosis: I disagreed with the “Halstedian” approach to diagnostic confirmation advanced in the article. See Scadding, above. We estimated a 99.95% positive predictive value for the clinical diagnosis of stage I disease. (Reich JM, Brouns MC, O’Connor EA, Edwards MJ. Mediastinoscopy in patients with presumptive stage I sarcoidosis: a risk/benefit, cost/benefit analysis. Chest 1998;113(1):147-53). The joint guideline article you cited (67), with which I agree, cited a similar clinical PPV. The PPV for stage II is nearly as high.  
4.	Treatment absent compelling symptoms: Ref 67 cites progression, not duration of pulmonary involvement as the treatment indication. There is persuasive evidence that suppression of the early immune response interferes with its resolution, thereby worsening its outcome. (Reich JM. Mortality of intrathoracic sarcoidosis in referral vs. population-based settings: influence of stage, ethnicity, and corticosteroid therapy. Chest 2002;121:32-39. Reich JM. Adverse long-term effect of corticosteroid therapy in recent-onset sarcoidosis. Sarcoidosis Vasc Diffuse Lung Dis. 2003;20(3):227-34. Reich JM. Con: The treatment of the granulomatous response is beneficial in acute sarcoidosis [Debate]. Respir Med 2010;104:1778-81 and 1782-83. [Pro: Culver DA. Complete debate: 1775-83.]
5.	Neoplasia: There is persuasive evidence that intratumoral, local, regional and systemic granulomatous responses (“sarcoidosis”) to neoplasia represent a continuum. (Reich JM, Mullooly JP, Johnson RE. Linkage analysis of malignancy-associated sarcoidosis. Chest 1995;107:605-13. Reich JM. Neoplasia in the etiology of sarcoidosis. Eur J Intern Med 2006;17(2):81-87. Reich JM. Neoplasia in the etiology of sarcoidosis [Letter]. Amer J Med 2013;126(1):e17. doi: 10.1016/j.amjmed.2012.05.031
A systemic granulomatous response to neoplasia risks the possibility of being mistaken for metastatic carcinoma. Sarcoidosis does not simulate cancer. Isolated bilateral hilar adenopathy is easily distinguished from anterior mediastinal adenopathy, the latter being the typical appearance of intrathoracic lymphoma. 
6.	Epidemiology: Your uncited incidence figure seems too high. Constraints, data and incidence classification are furnished in: Reich JM. A Critical analysis of sarcoidosis incidence assessment [Commentary]. Multidiscip Respir Med 2013, 8:57. DOI: 10.1186/10.1186/2049-6958-8-57
7.	Other causes: I challenged these causal inferences on the basis of their methodological flaws. Reich JM. Shortfalls in imputing sarcoidosis to occupational exposures [Editorial]. Amer J Ind Med. 2013;.56:496-500. doi: 10.1002/ajim.22083.
8.	Fundamental nature: I furnished a view of sarcoidosis—an etiologically heterogeneous, systemic granulomatous default response, attributable to inefficient cellular immune processing, most often of unknown cause—that  accounts for the spectrum of otherwise enigmatic features: elusiveness of “the” causal agent; the “immune paradox”; its development in response to a variety of identified antigenic sources; the vulnerability to its development imposed by diverse cellular immunological deficiencies; the seemingly paradoxical (i.e., favorable) relationship to the intensity of the cellular response; the nature of the Kveim response; and the adverse impact of immunosuppression in recent-onset disease. (Reich JM. On the nature of sarcoidosis. Eur J Intern Med; 2012 (23):105-109. 10.1016/j.ejim.2011.09.011)
9.	Auscultation: One of the striking findings is the absence of adventitious breath sounds in sarcoidosis even in the presence of extensive pulmonary shadowing, a finding that helps distinguish it from other causes of diffuse pulmonary shadowing. 
I hope you find this information useful. 
Reichje (talk) 16:54, 28 November 2013 (UTC)
thread_title:  Suggested additions, modifications and corrections 

message: doi:10.1056/NEJMra2101555 JFW | T@lk 13:22, 13 September 2021 (UTC)
thread_title:  NEJM