Clinical Management Of Extrapulmonary Sarcoidosis: A Comparative Analysis Of Treatment Effects On Organ-Specific Involvement And Biochemical Parameters In Sarcoidosis Management

Abstract

Introduction:Extrapulmonary sarcoidosis is a complex multisystem disorder presenting diagnostic and therapeutic challenges. This study aims to evaluate and compare the effectiveness of immunosuppressants, TNF-α inhibitors, and corticosteroids in managing organ involvement and laboratory parameters in extrapulmonary sarcoidosis patients.

Method:This prospective case-control study was conducted at Al-Azhar hospital in Assuit, Egypt. Patients with confirmed extrapulmonary sarcoidosis were assigned to treatment groups based on immunosuppressants, tumor necrosis factor alpha (TNF-α) inhibitors, or corticosteroids, alongside healthy controls. Data, including clinical evaluations, laboratory tests, and imaging, were collected at baseline, 6 months, and 1 year. Clinical, laboratory, and radiological assessments of organ involvement were performed regularly to monitor disease progression and treatment response. Data were compared between treatment groups using statistical tests.

Results: Immunosuppressants improved ocular and neurological symptoms, TNF-α inhibitors prevented ocular worsening and enhanced neurological outcomes, and corticosteroids steadily reduced both; liver involvement decreased similarly across groups, while cardiac involvement varied, with immunosuppressants reducing it by one year and the other treatments showing temporary increases before improvement.The comparison of laboratory changes among sarcoidosis treatment groups showed that all treatments were associated with lower hemoglobin levels than healthy individuals, with TNF-α inhibitors having the greatest reduction; immunosuppressants led to the lowest white blood cell (WBC), platelet counts, and angiotensin-converting enzyme (ACE)levels were similar across groups. Calcium levels were elevated mainly in the corticosteroid group, and alkaline phosphatase levels were lower in the immunosuppressant and corticosteroid groups compared to TNF-α inhibitors and healthy controls. Despite significantly higher extrapulmonary involvement in all treatment groups compared to healthy individuals, no differences were observed between them.

Conclusion:In conclusion, the results demonstrate distinct effects of immunosuppressants, TNF-α inhibitors, and corticosteroids on sarcoidosis manifestations, highlighting the importance of individualized treatment approaches to optimize outcomes across organ involvement and laboratory parameters in this complex disease.