Sarcoidosis Interesting that smoking seemingly protects from this disease

[Guest guest]

Interesting that smoking seemingly protects from this disease.

Sarcoidosis

http://www.medscape.com/viewarticle/496208

Dec. 17, 2004 � A case-control study published in the Dec. 15

issue of the American Journal of Respiratory & Critical Care

Medicine suggests environmental and occupational risk factors for

sarcoidosis.

" The prevailing view suggests that sarcoidosis occurs as the

consequence of exposure to one or more environmental agents

interacting with genetic factors, " write Lee S. Newman, MD, MA, from

the National Jewish Medical and Research Center and University of

Colorado Health Sciences Center in Denver, Colorado, and

colleagues. " Previous investigators have suggested that

environmental exposures to microbial agents may prove causative

because of their infectious and/or antigenic properties. "

At 10 centers, the investigators recruited and interviewed 706

patients newly diagnosed as having sarcoidosis and an equal number

of age-, race-, and sex-matched control subjects, using

questionnaires regarding occupational and nonoccupational exposures.

Univariable analyses demonstrated positive associations between

sarcoidosis and agricultural employment (odds ratio [OR], 1.46;

confidence interval [CI], 1.13-1.89), work exposure to insecticides

(OR, 1.52; CI, 1.14-2.04), and work environment containing mold or

mildew with possible exposure to microbial bioaerosols (OR, 1.61;

CI, 1.13-2.31).

Compared with control subjects, those with sarcoidosis were less

likely to have a history of ever smoking cigarettes (OR, 0.62; CI,

0.50-0.77). Multivariable modeling suggested increased sarcoidosis

risk for work in areas with musty odors (OR, 1.62; CI, 1.24-2.11)

and for occupational exposure to insecticides (OR, 1.61; CI, 1.13-

2.28), and a decreased OR related to ever smoking cigarettes (OR,

0.65; CI, 0.51-0.82).

" The study did not identify a single, predominant cause of

sarcoidosis, " the authors write. " We identified several exposures

associated with sarcoidosis risk, including insecticides,

agricultural employment, and microbial bioaerosols. "

Study limitations include potentially missing risk factors not

considered in questionnaire design, the possibility that some of the

statistically significant results may have occurred due to chance

alone, possible ascertainment bias, failure of many potential

control subjects to participate in the study, differential

information bias, and recall bias.

" Sarcoidosis is considered to be a hypersensitivity disorder, in

which an antigen induces a T cell-mediated cellular immune response.

As a result, it is possible that the etiologic agent or agents may

initiate disease at very low doses of exposure, " the authors

conclude. " Efforts should be directed at integrating exposure data

with our emerging understanding of other sarcoidosis risk modifiers

such as tobacco use, genetics, and familial aggregation. "

Two of the authors report a financial relationship with Centocor.

Am J Respir Crit Care Med. 2004;170:1324-1330

Learning Objectives for This Educational Activity

Upon completion of this activity, participants will be able to:

* Identify the differential diagnosis of sarcoidosis based on

clinical and pathologic features.

* Describe environmental and occupational exposures that can

increase the risk of developing sarcoidosis.

Clinical Context

Sarcoidosis is thought to be the result of an antigen-specific cell-

mediated immune response, and the authors of the current study note

that sarcoidosis can be difficult to distinguish in terms of

clinical and histologic clues from other disease states associated

with antigen exposure. These antigen-related disorders include

chronic beryllium disease, hypersensitivity pneumonitis due to

inhaled antigens, and fungal and mycobacterial antigen-induced

granulomatous lung disease.

An increased risk of sarcoidosis has been associated with those

working in multiple occupations, including firefighting and health

care, and environmental exposures to mold or agricultural products.

Because the significance of these possible risk factors remains

controversial, the authors of the current study performed a

multicenter case-control examination of patients with sarcoidosis.

Study Highlights

* Ten centers participated in the study. Subjects with

sarcoidosis were included if they had tissue confirmation of

noncaseating granulomas on biopsy within 6 months of study

enrollment, clinical signs and symptoms of sarcoidosis, and if they

were older than 18 years. Subjects with tuberculosis were excluded,

as were most patients with a history of beryllium exposure.

* Control subjects were recruited by randomized dialing of

telephone numbers.

* All participants received questionnaires regarding specific

jobs, hobbies, and exposures at home and work. They were interviewed

regarding all jobs held within the previous 6 months, and smoking

status was ascertained.

* 736 patients with sarcoidosis were recruited into the study,

and they were compared with 706 controls. 64% of cases were women,

and 53% of all subjects were white. 44% of participants were black.

The median age of cases was 42.1 years.

* On univariable analysis, occupations associated with an

increased risk of sarcoidosis included agricultural employment,

physician, jobs involving raising birds, automotive manufacturing,

and middle and secondary school teacher.

* Exposures more frequently associated with sarcoidosis included

insecticides, pesticides, mold and mildew, and musty odors. All of

these exposures were related to the subject's occupation, but the

use of home central air conditioning was also associated with an

increased risk of sarcoidosis.

* Location in urban vs rural areas did not affect the risk of

sarcoidosis, and other health care workers besides physicians did

not have an increased risk of disease.

* A reduced risk of sarcoidosis was associated with either active

or passive smoking, and subjects with occupations that limited

exposure to other people, such as motor vehicle operator or computer

programmer, were also at reduced risk of sarcoidosis.

* Multivariable analysis confirmed most of the univariable

conclusions of the study. In the multivariable model, the occupation

of physician was no longer associated with an increased risk of

sarcoidosis.

* The authors did not confirm previous reports of an increased

risk of sarcoidosis related to exposure to wood dust, metals,

silica, or talc. They also did not demonstrate that employment as a

firefighter or in the U.S. Navy was associated with sarcoidosis,

although the researchers note that their study may not have been

adequately powered to appropriately analyze these possible risk

factors.

Pearls for Practice

* Sarcoidosis can be mistaken on clinical and pathologic findings

for exposure diseases such as hypersensitivity pneumonitis, chronic

beryllium disease, and mycobacterial and fungal granulomatous

disease.

* The current study found an increased risk of sarcoidosis

associated with agricultural employment and exposure to pesticides,

but smoking conferred protection against the development of

sarcoidosis.

Post Test

1. Which of the following is least likely to be part of the

differential diagnosis of a patient with pulmonary sarcoidosis who

has undergone a lung biopsy?

a. Chronic beryllium disease

b. Fungal granulomatous disease

c. Mycobacterial granulomatous disease

d. Hypersensitivity pneumonitis

e. Mesothelioma

2. Which of the following risk factors was not associated with a

higher risk of sarcoidosis in the current study by Newman and

colleagues?

a. Agricultural employment

b. Smoking

c. Employment in automotive manufacturing

d. Pesticide exposure

e. Mold exposure

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Medscape Medical News 2004. © 2004 Medscape

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Administration. A qualified health care professional should be

consulted before using any therapeutic product discussed. All

readers or continuing education participants should verify all

information and data before treating patients or employing any

therapies described in this educational activity.

[Guest guest]

it is pretty interesting and I have researched sarcoidosis quite a

bit and have some thoughts on this.

the navy has done a lot of research as they seem to deal with this

disease alot. they deturmined it was caused by toxins,molds and

bacterias. who would have guessed, anyway, sence I live diagnoseing

myself, I have xame to some very interesting conclusions on this.

I smoke. and ny exposure in my second home was so bad it fulled my

lungs with mold and no dought, the distroyed mucus. I had hardly any

bteathing compasity at all, however after I got out of there I

started coughing up goobs of all colored mucus from my lungs and

slowly regained my breathing compasity. now theres things going on

infront of my lungs, swelling and pain against my rib cage,breasts,

and alot of pain,burning on my back. but other than the closeing up

of my airways when I get around things that cause reaction, my lungs

theirself only hurt when I breath something that causes a infection

or something like nemonia(spelling),maybe cold air but maybe whats in

the cild air ? can hurt too. but anyway, I had read that lung

infections can go straight into the cns so I thought this was what

was happening but it didn't quite fit the diagnoses because these cns

infections didn't just happen when my lungs hurt. so I continued

lookung, and mainly because of the burning on my back side I needed

to understand just what was happening there. than I went back to the

cns,arachnoid, and waalaam it was right there staring me in the face

and it all fit together. I now understand why my tremors happen from

the waist down, because they happen from the point that the DDD and

sponalcord adhesionm severe arachnoiditis was wotking it's way up my

back. the butning pain on my back side above this point being part of

whats going on with no dought arachnoid cysts there and the damage to

the malyein sleath and because of that damage and infections and

damage to the arachnoid villa,brain infection is part of that, and my

cat scan report says several cysts in the frontal lobes and decreased

white and gray matter. thats not all it shows but at least that was

igknowledged. I also got the report from the neuro-opthamologest

saying the cataracts cant be removed until other health problems are

under control. hey, not bad considering what I've been up against

which I cant get into at this time. anyway, I suppose that if I went

to a sarcoidosis doctor, I'd probably get diagnosed with

neurisarcoidosis, one of those rare cases where the lungs seemed to

not be as invilved yet maybe still with phurel effusion(fluid in the

lineing of the lungs and possably granulomas).

--- In , " tigerpaw2c " <tigerpaw2c@...>

wrote:

>

> Interesting that smoking seemingly protects from this disease.

>

> Sarcoidosis

>

> http://www.medscape.com/viewarticle/496208

>

> Dec. 17, 2004 � A case-control study published in the Dec. 15

> issue of the American Journal of Respiratory & Critical Care

> Medicine suggests environmental and occupational risk factors for

> sarcoidosis.

>

>