There
has been a rapid change in recognition and spectrum of sarcoidosis in
India in the last decade. This was considered a rare disease almost till
the end of the last century even though the disease was recognized and
reported from different places. The change is remarkable considering the
fact that the number of publications on the subject has suddenly jumped
in the last decade. Of 340 total papers which are listed in PubMed
since 1980, about two-third (228) have appeared in the last 10 years.
There were only rare publications before 1980. The increase can be
attributed to several different causes:
- True increase in incidence
- Increased awareness of disease among physicians. Many cases of sarcoidosis were dismissed as tuberculosis in the past.
- Increased availability of diagnostic tests such as chest CT scanning, fiberoptic bronchoscopy and endo-bronchial ultrasound sound guided fine needle aspiration (EBUS-FNA)
- Insistence of physicians as well as patients in making a confirmed diagnosis than starting anempiric treatment
Clinical spectrum of sarcoidosis:
There is also a change in the spectrum of disease and organ involvement
described in the reports of the recent past. Previously, it was mostly
the pulmonary involvement i.e. hilar and mediastinal lymphadenopathy
which was commonly described. Now, there is a greater recognition of
extra-pulmonary involvement including that of the liver, spleen, nervous
system and other organs. Moreover, atypical pulmonary presentations
such as miliary involvement of lung parenchyma and pleural effusions are
frequently reported. It is again a moot question whether this finding
is a true change in the spectrum or only an increased recognition
because of the factors already listed above.
Sarcoidosis
tuberculosis enigma continues to bother physicians in India not only
because of similar presentations of both diseases but also since the
treatments are different for the two diseases. Corticosteroids, which
are used for sarcoidosis may in fact precipitate tuberculosis and are
necessarily avoided except in a few specific situations. There is no
place to start the treatments for both conditions simultaneously as had
been a common practice in the past. It is therefore important to make a
firm diagnosis before starting treatment for either condition.
The
other major shift which has happened relates to the more frequent use
of non-steroidal drugs. Drugs such as methotrexate, hydroxy chloroquin
and other immunosuppressants are now available for use for relapse and
in the presence of co-morbidities with or without corticosteroid
therapy, depending upon the clinical condition.
S.K. Jindal
Medical Director, Jindal Clinics, Chandigarh
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