Department of Geriatric Medicine, Galway University Hospital, Galway, Ireland.
Interventional Respiratory Unit, Department of Respiratory Medicine, Galway University Hospital, Galway, Ireland.
Age Ageing. 2022 Sep 2;51(9). doi: 10.1093/ageing/afac203.
Sarcoidosis is a multi-system disorder with an increasing propensity to present in older patients. Diagnostic uncertainty is common and understandable given the higher prevalence of co-morbidities in older patients and broad differential for multi-system clinical presentations. Excluding malignancy and infection with a high degree of certainty is challenging and may require repeated confirmatory investigation where the diagnosis remains in doubt.
There are a paucity of studies examining late-onset sarcoidosis. Female predominance, pulmonary, ocular, skin and systemic symptoms are common, while more classical presentations such as Lofgren's syndrome are uncommon. Positivity rates of biopsies vary between studies; however, targeted biopsies of accessible sites with organ involvement are the most successful. Therapeutic management is directed at reducing inflammation, and thereby reducing symptom burden, improving quality of life and avoiding progression of organ damage. While most older patients will require corticosteroid therapy, they are also more prone to developing adverse effects. Most older patients will experience a clinical remission; however, the risk of developing chronic sarcoidosis and organ damage is higher compared with younger counterparts. Patients with evidence of pulmonary fibrosis and pulmonary hypertension are at particular risk.
Health care providers who care for older adults should be aware of the increasing prevalence of late-onset sarcoidosis and consider the diagnosis in those who present with otherwise unexplained systemic symptoms, thoracic abnormalities on imaging and/or evidence of other organ involvement. Earlier diagnosis and therapeutic intervention to halt the development of pulmonary fibrosis and pulmonary hypertension and monitoring for treatment-related adverse effects will confer a mortality benefit.
结节病是一种多系统疾病，越来越倾向于在老年患者中出现。鉴于老年患者合并症的患病率较高，以及多系统临床表现的广泛差异，诊断不确定性较为常见且可以理解。排除恶性肿瘤和感染的确定性较高，但可能需要反复进行确认性检查，如果诊断仍有疑问。
研究老年发病结节病的研究较少。女性多见，肺部、眼部、皮肤和全身症状常见，而更经典的表现如洛夫格伦综合征则不常见。活检的阳性率在不同的研究中有所不同；然而，对有器官受累的可及部位进行靶向活检是最成功的。治疗管理旨在减轻炎症，从而减轻症状负担，提高生活质量并避免器官损害的进展。虽然大多数老年患者需要皮质类固醇治疗，但他们更容易发生不良反应。大多数老年患者将经历临床缓解；然而，与年轻患者相比，发生慢性结节病和器官损害的风险更高。有肺纤维化和肺动脉高压证据的患者风险特别高。
照顾老年人的医疗保健提供者应意识到老年发病结节病的患病率增加，并在出现其他原因不明的全身症状、影像学上有胸壁异常和/或其他器官受累证据的患者中考虑诊断。早期诊断和治疗干预以阻止肺纤维化和肺动脉高压的发展，并监测治疗相关的不良反应，将带来生存获益。
