Response to: Baughman RP, Nunes H. Therapy for sarcoidosis: evidence-based recommendations. Expert Rev. Clin. Immunol. 8(1), 95–103 (2012).
I read with great interest the recent article by Baughman and Nunes Citation[1]. An aspect of sarcoidosis that is often forgotten is disease-associated fatigue and lassitude.
Younger individuals afflicted with sarcoidosis report more fatigue than older patients Citation[2]. Moreover, fatigue is more common in females than in males. Nearly 47% of male patients with sarcoidisis have decreased testosterone levels Citation[3]. This further contributes to sarcoidosis-associated fatigue. Similarly, sarcoidoisis may result in panhypopituitarism-associated diabetes insipidus that may further accentuate the fatigue Citation[4]. Patients with sarcoidosis-associated fatigue report a poor response in all domains of the WHO ‘quality of life’ scale Citation[5].
Patients with sarcoidosis and associated fatigue demonstrate attenuated levels of MCP-1 Citation[6]. On the same hand, these patients demonstrate accentuated levels of IL-8. Similarly, there is a negative association between sarcoidosis-associated fatigue and plasma IL-10 and IL-4 levels.
Recently, methylphenidate has been successfully used for mitigating and decreasing fatigue in patients with sarcoidosis. This has been confirmed by Lower et al. in a recent study Citation[7]. Similarly, armodafinil has been successfully used recently for attenuating sarcoidosis-associated fatigue Citation[8].
The aforementioned examples clearly illustrate the importance of sarcoidosis-associated fatigue and the need to increase awareness about it among physicians, especially pulmonologists.
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References
- Baughman RP, Nunes H. Therapy for sarcoidosis: evidence-based recommendations. Expert Rev. Clin. Immunol. 8(1), 95–103 (2012).
- Hinz A, Fleischer M, Brähler E, Wirtz H, Bosse-Henck A. Fatigue in patients with sarcoidosis, compared with the general population. Gen. Hosp. Psychiatry 33(5), 462–468 (2011).
- Spruit MA, Thomeer MJ, Gosselink R et al. Hypogonadism in male outpatients with sarcoidosis. Respir. Med. 101(12), 2502–2510 (2007).
- Miyoshi T, Otsuka F, Takeda M et al. An elderly patient with sarcoidosis manifesting panhypopituitarism with central diabetes insipidus. Endocr. J. 54(3), 425–430 (2007).
- Michielsen HJ, Drent M, Peros-Golubicic T, De Vries J. Fatigue is associated with quality of life in sarcoidosis patients. Chest 130(4), 989–994 (2006).
- Korenromp IH, Grutters JC, van den Bosch JM, Zanen P, Kavelaars A, Heijnen CJ. Reduced Th2 cytokine production by sarcoidosis patients in clinical remission with chronic fatigue. Brain Behav. Immun. 25(7), 1498–1502 (2011).
- Lower EE, Harman S, Baughman RP. Double-blind, randomized trial of dexmethylphenidate hydrochloride for the treatment of sarcoidosis-associated fatigue. Chest 133(5), 1189–1195 (2008).
- Lower EE, Malhotra A, Surdulescu V, Baughman RP. Armodafinil for sarcoidosis-associated fatigue: a double‑blind, placebo-controlled, crossover trial. J. Pain Symptom Manage. doi:10.1016/j.jpainsymman.2012.02.016 (2012) (Epub ahead of print).