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Sarcoidosis diagnosed in older patients linked to worse outcomes

In a new study, sarcoidosis appeared to require a high index of suspicion in elderly patients because older patients with pulmonary sarcoidosis presented with more severe disease and worse outcomes compared with younger patients.

Additionally, isolated extrapulmonary involvement at diagnosis and certain particular extrapulmonary organ involvement were more frequent among older patients.

“Sarcoidosis is an inflammatory disease with a usual onset between the third and fifth decades of life,” Manuel Rubio-Rivas, MD, clinician in the autoimmune diseases unit in the department of internal medicine at Bellvitge University Hospital-IDIBELL in Spain, and colleagues wrote. “This is a disease seldom diagnosed in the elderly. Reports focusing on this group of patients are scarce and, therefore, sarcoidosis behavior in these patients is poorly documented.”

The retrospective study included data on 615 consecutive patients treated for sarcoidosis between 1976 and 2018at the Bellvitge University Hospital — a tertiary care single-center in Barcelona, Spain.

Investigators sought to describe the clinical features and outcomes of sarcoidosis among older patients compared with younger patients. For the purpose of this study, researchers defined elderly sarcoidosis as sarcoidosis diagnosed in patients aged 65 years and older.

Overall, 47 patients (7%) were diagnosed with sarcoidosis.

Although Löfgren’s syndrome was the predominant mode of onset in younger patients (8.5% vs. 42.2%; P<.001), older patients were more likely to demonstrate radiographic stage 3 and stage 4 sarcoidosis (21.3% vs. 7.6%; P=.001), isolated extrapulmonary involvement (21.3% vs. 8.2%; P=.003), subcutaneous nodules (17% vs. 3.4%; P<.001) and intra-abdominal/retroperitoneal lymph nodes (23.4% vs. 9.5%; P=.003).

Moreover, older patients were less likely to achieve remission during follow-up (35% vs. 53%; P=.027) and had a higher incidence for pulmonary fibrosis (15% vs. 6.1%; P=.029). Sarcoidosis-associated mortality was more prevalent in older patients (6.4% vs. 1.3%; P=.036), the researchers reported. – by Jennifer Southall

Disclosures: The authors report no relevant financial disclosures.