For over seven decades, oral corticosteroids have been the cornerstone of sarcoidosis management. Oral corticosteroids suppress sarcoidosis inflammation rapidly, but long-term oral corticosteroids result in toxicity and some patients are unable to taper oral corticosteroids without experiencing disease flare ups. The routine use of oral corticosteroids as first-line therapy, as recommended in sarcoidosis guidelines, could have unintentionally promoted the long-term use of oral corticosteroids. We believe that oral corticosteroids should no longer be considered as first-line therapy in all patients with sarcoidosis requiring treatment. Furthermore, we view long-term use of oral corticosteroids in sarcoidosis as an undesirable outcome. When initial oral corticosteroids are required, we propose that oral corticosteroids be used as bridging therapy, ideally for no longer than 3-4 months. There is an urgent need to address the widespread use of long-term maintenance therapy with oral corticosteroids in patients with sarcoidosis, and we advocate the systematic withdrawal of steroid therapy with replacement, if necessary, by other immunosuppressive agents.

BACKGROUND:Oral corticosteroids (OCSs) are recommended as first-line therapy for sarcoidosis, yet limited data describe the risk of steroid-associated adverse effects in this population. RESEARCH QUESTION:What are the short-term and long-term effects of OCS exposure in terms of developing steroid-related comorbidities in a multinational cohort with sarcoidosis? STUDY DESIGN AND METHODS:An electronic questionnaire was codeveloped and translated by an international team of sarcoidosis experts and patients from the United States and Europe. We used inverse probability weighting to estimate the average treatment effect on the treated adjusted for markers of disease severity. Before data collection, we prespecified 2 primary outcomes: (1) development of 13 steroid-associated comorbidities and (2) total weight change. Outcomes were compared across patients with OCS exposure categorized as current, past, or never. RESULTS:We collected self-reported questionnaires from 1,937 patients with sarcoidosis representing 34 countries. In weighted analyses, ever use of OCSs (current or past OCS use) was associated with development of 1.3 more comorbidities (95% CI, 0.8-1.9) compared with never using OCSs. Ever use of OCSs was associated with increased odds for the development of mood changes (OR, 2.1; 95% CI, 1.3-3.4), gastroesophageal reflux disease (OR, 2.3; 95% CI, 1.3-4.1), bruising (OR, 2.3; 95% CI, 1.3-4.1), osteoporosis (OR, 3.8; 95% CI, 1.8-8.1), hyperlipidemia (OR, 1.9; 95% CI, 1.04-3.5), infections (OR, 2.1; 95% CI, 1.1-4.0), and diabetes (OR, 2.7; 95% CI, 1.2-6.0). Ever use of OCSs was associated with 5.9 kg (95% CI, 3.8-8.0 kg) more net weight gain than never use. The effects of OCS use were more pronounced between ever and never OCS users and were similar between current and past OCS users. INTERPRETATION:Ever use of OCSs was associated with multiple steroid-related comorbidities and weight gain in patients with sarcoidosis. Notably, adverse effects persisted even after OCS discontinuation.

By Rutva Patel, Biological Sciences and Neurobiology Advisor: Robert P. Baughman Abstract: Methods: Patients identified at UC Medical Center Sarcoidosis Clinic over past 8 years. Patients with optic neuritis & biopsy confirmed sarcoidosis were identified & demographic information, organ involvement, treatment, and outcome were noted. These were compared to sarcoidosis patients without optic neuritis. Results: Forty (1.7%) of 2260 sarcoidosis patients in our registry had optic neuritis & biopsy confirmed sarcoidosis. This included 25 women & 25 Caucasians, which was not significantly different from the control group. Twenty (50%) of the optic neuritis patients had other eye involvement, usually uveitis, compared to only 678 of the controls (30.5%, Chi square=6.967, p=0.0083). Other neurologic disease was identified in 24 of 40 (60%) of the optic neuritis patients versus 425 of the controls (19.1%, Chi square=41.179, p

Background: Idiopathic granulomatous mastitis is a rare benign breast disease of women of reproductive age. It usually presents as a painful mass. Since the etiology is unclear, directed diagnosis and management is lacking. Methods: This is a retrospective chart review of 14 patients, over twelve years (2004-2016), identified through query of pathology findings. Results: Two asymptomatic patients were diagnosed after oncologic breast resection following neoadjuvant chemotherapy. The remaining twelve patients were young (31.7 years, range 23-43 years), predominantly non-white (50% African/African-American, 36% Hispanic, 7% Asian), pregnant within the last five years (86%), with no prior granulomatous disease. Evaluation included breast imaging, microbial cultures and staining, and biopsy. Treatment included antibiotics (57%), corticosteroids (21%), methotrexate (7%), and/or surgery (71%). Imaging suggests segmental masses, possibly abscess. Conclusion: Granulomatous mastitis is uncommon, and difficult to diagnose and manage. We review our experience, the literature, and propose an algorithm for diagnosis and management. (C) 2017 Elsevier Inc. All rights reserved.