Sarcoidosis: global scenario & Indian perspective

Abstract

Sarcoidosis is now recognised as a member of a large family of granulomatous disorders and has been reported from all parts of the world. Current evidence points to genetic predisposition and exposure to yet unknown transmissible agent(s) and/or environmental factors as etiological agents. Depending on the organ systems involved, patients with sarcoidosis present themselves to various specialities; pulmonary involvement is by far the commonest and occurs in about 90 per cent of the patients. The diagnosis is based on a compatible clinical and/or radiological picture, histopathological evidence of non-caseating granulomas in tissue biopsy specimens and exclusion of other diseases capable of producing similar clinical or histopathological appearances. Sarcoidosis is an underdiagnosed disease in India. However, owing to the increasing awareness, it is being diagnosed more frequently than a few decades ago. Most Indian patients with sarcoidosis are males and present in the fourth or fifth decade of life. The disease runs a benign course with spontaneous remission of the activity though some degree of residual pulmonary function abnormality persists. Only a minority of the patients develop complicated disease. Corticosteroids remain the mainstay of treatment. For asymptomatic patients with pulmonary sarcoidosis, no therapy is required. Corticosteroid treatment should be considered in symptomatic patients with evidence of radiological or pulmonary function deterioration. Treatment under close clinical monitoring should be tailored to suit the needs of the individual patient. Sometimes steroid-sparing alternative treatments may be beneficial. In this review, the current understanding of the global scenario and Indian perspective of sarcoidosis are critically reviewed.