Associations between occupational and environmental exposures and organ involvement in sarcoidosis: a retrospective case-case analysis

Steven Ronsmans,Jonas Yserbyt,Peter H M Hoet,Jolien De Ridder,Steven Vanderschueren,Wim A Wuyts,Stephan Keirsbilck,Eline Vandebroek,Benoit Nemery

doi:10.1186/s12931-021-01818-5

Abstract

BackgroundSarcoidosis most commonly affects lungs and intrathoracic lymph nodes, but any other organ can be involved. In epidemiological studies, many occupational and environmental exposures have been linked to sarcoidosis but their relationship with the disease phenotype has barely been studied.ObjectiveTo investigate how occupational and environmental exposures prior to diagnosis relate to organ involvement in patients with sarcoidosisMethodsWe retrospectively studied patients seen at a sarcoidosis clinic between 2017 and 2020. Patients were included if they had a clinical presentation consistent with sarcoidosis and histologically confirmed epithelioid granulomas or had Löfgren syndrome. In a case–case analysis using multivariable logistic regression we calculated odds ratios (OR) of prespecified exposure categories (based on expert ascertainment) for cases with a given organ involvement versus cases without this organ involvement.ResultsWe included 238 sarcoidosis patients. Sarcoidosis limited to pulmonary involvement was associated with exposure to inorganic dust prior to diagnosis (OR 2.11; 95% confidence interval [CI] 1.11–4.17). Patients with liver involvement had higher odds of contact with livestock (OR 3.68; 95% CI 0.91–12.7) or having jobs with close human contact (OR 4.33; 95% CI 1.57–11.3) than patients without liver involvement. Similar associations were found for splenic involvement (livestock: OR 4.94, 95% CI 1.46–16.1; close human contact: OR 3.78; 95% CI 1.47–9.46). Cardiac sarcoidosis was associated with exposure to reactive chemicals (OR 5.08; 95% CI 1.28–19.2) or livestock (OR 9.86; 95% CI 1.95–49.0). Active smokers had more ocular sarcoidosis (OR 3.26; 95% CI 1.33–7.79).ConclusionsOur study indicates that, in sarcoidosis patients, different exposures might be related to different organ involvements—hereby providing support for the hypothesis that sarcoidosis has more than one cause, each of which may promote a different disease phenotype.

Highlights

Sarcoidosis most commonly affects the lungs and intrathoracic lymph nodes, but any organ can be involved [1, 2]
Our study indicates that, in sarcoidosis patients, different exposures might be related to different organ involvements—hereby providing support for the hypothesis that sarcoidosis has more than one cause, each of which may promote a different disease phenotype
Active smokers had more ocular sarcoidosis and were possibly more likely to have skin granulomas

Summary

Introduction

Sarcoidosis most commonly affects the lungs and intrathoracic lymph nodes, but any organ can be involved [1, 2]. Many occupational and environmental exposures have been linked to sarcoidosis, such as organic dust [3,4,5], inorganic dust (including metals and minerals) [6, 7], and infectious agents (including mycobacteria and Cutibacterium acnes) [8]. It is unclear whether these exposures are truly ‘causing’ the disease, whether they render the immune system more susceptible to the development of sarcoidosis, or whether they exacerbate subclinical cases. Many occupational and environmental exposures have been linked to sarcoidosis but their relationship with the disease phenotype has barely been studied

Methods

Results

Discussion

Conclusion