Department of Nephrology and Rheumatology, University Medical Center Göttingen, Göttingen, Germany.
Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA.
Curr Opin Pulm Med. 2018 Sep;24(5):504-512. doi: 10.1097/MCP.0000000000000500.
Sarcoidosis is a rare, multisystem granulomatous disease of incompletely understood pathogenesis. Clinically, it shares common features with several systemic and organ-specific autoimmune diseases, although known autoantibodies or useful serologic markers for diagnosis and monitoring of disease activity are lacking. Sarcoidosis can both coexist with or mimic connective tissue diseases or vasculitis. Here, we review possible common etiologic factors between sarcoidosis and autoimmune disease, comparing clinical, laboratory and imaging features.
Autoimmune diseases may precede or follow the diagnosis of sarcoidosis. Overall, the prevalence of both co-existing is unknown because of limited evidence. The presence of autoantibodies in sarcoidosis should raise suspicion of an underlying autoimmune disease that mimics or co-occurs with sarcoidosis. Silica dust exposure has been associated with an increased prevalence of both sarcoidosis and rheumatoid arthritis. In another study, autoimmune thyroid disease, Sjogren's syndrome and ankylosing spondylitis have been reported to be more frequent in sarcoidosis compared with healthy controls.
A systematic diagnostic work-up is necessary to detect overlapping disease features in patients with sarcoidosis. Immune-modulating therapies need to be taken into account as these can induce paradoxical reactions.
结节病是一种罕见的多系统肉芽肿性疾病，其发病机制尚未完全阐明。临床上，它与几种系统性和器官特异性自身免疫性疾病具有共同特征，尽管缺乏已知的自身抗体或用于诊断和监测疾病活动的有用血清标志物。结节病既可以与结缔组织病或血管炎并存，也可以模仿这些疾病。在此，我们将比较结节病和自身免疫性疾病的临床、实验室和影像学特征，探讨两者之间可能存在的共同发病因素。
自身免疫性疾病可能先于或后于结节病的诊断。由于证据有限，总体而言，同时存在这两种疾病的患病率尚不清楚。结节病中存在自身抗体时，应怀疑存在潜在的自身免疫性疾病，该疾病可能模仿或与结节病同时发生。二氧化硅粉尘暴露与结节病和类风湿关节炎的患病率增加有关。在另一项研究中，与健康对照组相比，结节病患者中更常出现自身免疫性甲状腺疾病、干燥综合征和强直性脊柱炎。
有必要对结节病患者进行系统的诊断性检查，以发现重叠的疾病特征。需要考虑免疫调节治疗，因为这些治疗可能会引发矛盾反应。
