Friday, April 25, 2014
Prognosis of My Sarcoidosis
I am a 35 yr old male , non smoker with tender red lumps over my ant. legs and ankle swelling. I am a non-smoker but have had inc. dyspnea for 3 weeks. my cxr shows hilar adenopathy and my PFT shows FVC of 70% predicted with a decreased DLCO. My perif eos are 3,000 and I am HLA-DRB1-03+. Will I be most likely to expect resolution in the next 2 years or have exacerbations and remissions over the next several years?
Dear Sir- As you imply, there are distinct clinical sarcoidosis presentations that appear to be influenced by genetics (e.g., HLA-DRB1-03+ allele tends to have a better prognosis). These genetic markers are fairly good for predicting clinical patterns in larger populations; however, they are not as reliable for predicting how the disease will manifest in an individual patient.
The painful rash on your legs is most likely caused by "erythema nodosum", an inflammatory response in the tissues under the skin. This is not actually caused by sarcoidosis (i.e., granulomas), but is characteristic of sarcoidosis that it is very active at first ("acute sarcoidosis") and tends to spontaneously remit. Again, these are not perfect predictors, and some patients require ongoing treatment even when they have these encouraging signs. Based on what little I know about your disease, I would be cautiously optimistic that the disease will become less active over the next few years.
For more information, the Foundation of Sarcoidosis Research (http://www.stopsarcoidosis.org/) has a nice summary of the signs and symptoms of sarcoidosis and information relating to prognosis and treatment.
Elliott D Crouser, MD
Associate Professor of Pulmonary, Allergy, Critical Care & Sleep Medicine
College of Medicine
The Ohio State University