Sarcoïdose pulmonaire : aspects cliniques et modalités thérapeutiques
Autor: | Hilario Nunes, D. Piver, Yurdagul Uzunhan, F. Crockett, Florence Jeny, Dominique Valeyre, Marianne Kambouchner |
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Rok vydání: | 2016 |
Předmět: |
medicine.medical_specialty
Lung medicine.diagnostic_test business.industry Chronic pulmonary aspergillosis Gastroenterology Disease medicine.disease Dermatology Pulmonary hypertension Natural history of disease 03 medical and health sciences 0302 clinical medicine medicine.anatomical_structure 030228 respiratory system Biopsy Internal Medicine medicine 030212 general & internal medicine Sarcoidosis Differential diagnosis business |
Zdroj: | La Revue de Médecine Interne. 37:594-607 |
ISSN: | 0248-8663 |
Popis: | Sarcoidosis is a granulomatous disease of unknown cause. This proteiform disease is characterized by an almost constant and often predominant lung involvement. The natural history of disease is difficult to predict at presentation. Diagnosis is based on a compatible clinical and radiological presentation and evidence of non-caseating granulomas. Exclusion of alternative diseases is also required according to clinical presentation. Biopsy samples of superficial lesions should be considered before other sites like per-endoscopic bronchial biopsies or endobronchial ultrasound-guided transbronchial needle aspiration. Therapeutic strategy for lung disease has to take into account the possible spontaneous resolution observed in newly diagnosed patients. Corticosteroids are the first choice when a treatment is decided, which concerns half of patients. Second and third line therapy are based respectively on immunosuppressive drugs and anti-TNFα drugs. Sarcoidosis mortality and morbidity are mainly linked to advanced pulmonary sarcoidosis - lung fibrosis, pulmonary hypertension, bronchial stenosis and chronic pulmonary aspergillosis. "Non anti-inflammatory" treatments have to be considered as well. Clinicians have an essential role in treatment indication, end-point targets and evaluation of response to treatment during follow-up and in finding the best benefice to risk balance. Progress made on pharmacogenetics may offer more personalized treatments for the patients. |
Databáze: | OpenAIRE |
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