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    Bone cysts in sarcoidosis
    (Springer Heidelberg, 2004) Yanardag, H; Pamuk, ÖN
    The incidence of bone cysts in sarcoidosis, a multisystemic disease, varies in different series, and these cysts are generally asymptomatic. We evaluated bone cysts in 516 sarcoidosis patients with available hand X-rays and in 200 patients with foot X-rays. Bone cysts were present in 21 cases (19 females, two males). The cysts were localized in phalanges of the hand in all cases, in feet in five cases, and in nasal bone in one. Six patients with bone cysts also had lupus pernio. Among those with cystic bone lesions, females were more frequent; extrapulmonary and skin involvement and lupus pernio were significantly more common. We diagnosed cystic bone lesions in 3.6% of our sarcoidosis patients and conclude that cysts were more frequent in females and in patients with lupus pernio.
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    Bone marrow involvement in sarcoidosis: an analysis of 50 bone marrow samples
    (Vsp Bv, 2002) Yanardag, H; Pamuk, GE; Karayel, T; Demirci, S
    The incidence of bone marrow involvement in sarcoidosis patients and changes in their peripheral blood parameters have been investigated. Out of 92 patients diagnosed with sarcoidosis at our center between 1994 and 2002, 50 (54.3%) gave consent for a bone marrow biopsy and were included into our study. The clinical features, peripheral blood parameters and bone marrow biopsy findings of the patients were analysed. Of these 50 patients, 39 were females and 11 were males (median age 37 years, range 16-62). Anemia was detected in 11 (22%) cases, and both anemia and leucopenia in 3 (6%). In 10% (5 patients; 3 males, 2 females) of the patients, bone marrow biopsy revealed noncaseified granulomas. Sarcoidosis patients with bone marrow involvement had higher incidences of extrapulmonary involvement, leucopenia-lymphopenia and anemia than those without involvement (P values were, 0.05, 0.001 and 0.06, respectively). Of the 11 patients with anemia, 3 had involvement of the bone marrow by sarcoidosis and 7 had iron deficiency anemia. As a result, bone marrow involvement should be considered in sarcoidosis patients with anemia, leucopenia-lymphopenia, and also extrapulmonary involvement.
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    Cutaneous involvement in sarcoidosis
    (W B Saunders Co Ltd, 2003) Yanardag, H; Pamuk, ÖN; Karayel, T
    In our study, we retrospectively evaluated the clinical features of patients diagnosed as sarcoidosis at our center within the Last 36 years and who had skin involvement. Cutaneous involvement was observed in 170 patients (32.9%, 136 females, 34 mates). The most frequent skin lesion was erythema nodosum (EN) (106 subjects, 20.5%). In addition, skin plaques and subcutaneous nodules were observed in 22 cases (4.3%), maculopapular eruptions in 19 cases (3.7%), scar lesions in 15 cases (2.9%), lupus pernio (LP) in 14 cases (2.7%) and psoriasiform plaques in five cases (0.9%). Among patients with LP (64.3%) and scar lesions (40%), pulmonary parenchymal involvement was more frequent than patients with other skin lesions. Parenchymal. involvement present in 10.4% of patients with EN was significantly less than in patients with LP and scar lesions (P values, respectively, <0.001, 0.002). When patients with skin involvement were compared to other sarcoidosis patients, it was seen that the frequency of females among those with skin involvement was significantly higher than the frequency among other sarcoidosis patients (P<0.001). Parenchymal involvement in sarcoidosis patients without skin involvement was less frequent than in patients with LP; however, more frequent than in patients with EN (both P values=0.002). As a conclusion, skin involvement was diagnosed in approximately one-third of our sarcoidosis patients with a generally female predominance. EN was the most frequent skin lesion encountered. Parenchymal involvement was more frequent in patients with LP and scar lesions and less frequent in patients with EN. (C) 2003 Elsevier Science Ltd. All rights reserved.
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    Lacrimal gland involvement in sarcoidosis -: The clinical features of 9 patients
    (E M H Swiss Medical Publishers Ltd, 2003) Yanardag, H; Pamuk, ÖN
    Patients and Methods: Ocular disease is relatively common in sarcoidosis and can be the initial clinical manifestation in some instances. In this study, we retrospectively evaluated the clinical and demographic features of 9 (1.74%) patients with lacrimal gland (LG) involvement out of 516 sarcoidosis patients who were followed up at our centre over the preceding 36-years. In addition, the characteristics of patients with LG involvement were compared to those of other cases with eye involvement and to other sarcoidosis patients. Results: In 5 subjects with LG involvement, the chest X-ray was normal. The number of stage 0 subjects among other sarcoidosis patients was significantly lower than among patients with LG involvement (p <0.001). In 2 of these cases, the diagnosis of sarcoidosis was reached by LG biopsy. The mean age of patients with LG involvement was significantly lower than that of other sarcoidosis patients (p <0.001). Also, sarcoidosis-related organ involvement - other than of the LG - was more frequent than in other sarcoidosis patients (p <0.001). Conclusions: It should be borne in mind that LG involvement might be the initial manifestation of sarcoidosis and the chest X-ray in these patients might be completely normal.
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    Lofgren syndrome in Turkey
    (Blackwell Publishing Asia, 2003) Yanardag, H; Pamuk, ÖN; Karayel, T
    In the 36-year period between 1966 and 2002, 514 patients were diagnosed with sarcoidosis at Cerrahpala Medical Faculty, Gstanbul, Turkey, and of these 98 (19.1%) had Lofgren syndrome. The frequency of female patients with Lofgren was higher than the frequency among other sarcoidosis patients (female : male ratio 4.8 vs. 1.64; P < 0.001). Erythema nodosum was diagnosed in 72.4% of the subjects and arthritis or arthralgia was diagnosed in 51%. Erythema nodosum and arthritis or arthralgia were more frequent in Lofgren; however, pulmonary parenchymal involvement was more frequent in other sarcoidosis patients (all P-values < 0.001).
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    Lupus pernio in sarcoidosis -: Clinical features and treatment outcomes of 14 patients
    (Lippincott Williams & Wilkins, 2003) Yanardag, H; Pamuk, ÖN; Pamuk, GE
    Lupus perio, (LP) is the most characteristic skin lesion of sarcoidosis. In this study, we retrospectively evaluated the clinical features of sarcoidosis patients with diagnosed LP at our center. Of 516 sarcoidosis patients diagnosed within a 36-year period, 14 (2.7%) had skin lesions that were clinically and histologically diagnosed as LP. Thirteen of our LP patients were females, and one was a male (mean age: 46.3, range: 24-67). In 2 sarcoidosis patients, the initial presentation of the disease was LP. When the LP patients were compared with other sarcoidosis patients, there were more fe- males, and the frequency of extrapidnionary involvement and the number of patients with advanced stage disease were higher (P <0.001). Oral and/or intralesional steroid therapy was the preferred treatment modality in all our patients and led to either recovery or regression in most patients with IP. As our study was an uncontrolled, retrospective one with few patients, it is difficult to say whether steroids are effective. LP runs a chronic course and spontaneous remission of lesions of more than 2 years' duration is quite rare. Because of the unwanted side effects of steroids, the efficacy of new treatment modalities should be tested especially in sarcoidosis patients with only skin involvement.
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    Older sarcoidosis patients
    (Lippincott Williams & Wilkins, 2004) Yanardag, H; Pamuk, ÖN
    Objectives: Although sarcoidosis is classically defined to be a disease of young adults, it might also be seen at older ages. There are very few clinical studies which focus on the features of patients diagnosed at older ages. In this study, we tried to determine the frequency of patients diagnosed at or above 50 years of age and to compare the clinical and demographic features of these subjects with other sarcoidosis patients. Methods: We evaluated the general clinical features of sarcoidosis patients more than 50 years of age who were diagnosed at our center within a 36-year period. We also compared the clinical features of older sarcoidosis patients with the features of other patients. Results: Of 579 sarcoidosis patients being followed up at our center, 102 (17.7%) were older than 50 years of age at the time of initial diagnosis. The female to male ratio in this group was higher than the ratio in other sarcoidosis patients (3.43 versus 1.85, P = 0.015). When the features of older patients were compared with other sarcoidosis patients, extrapulmonary involvement was observed to be more common in this group (P < 0.001). By contrast, arthritis or arthralgia (P < 0.001), clinical presentation in the form of Lofgren syndrome (P < 0.001), erythema nodosum (P < 0.001), and uveitis (P = 0.006) were less frequent. Conclusions: Although generally presenting as a disease of the young, in many subjects sarcoidosis is diagnosed at older ages, and this study indicates that the clinical features of sarcoidosis in older subjects differ from those found among younger patients.