Features of management of sarcoidosis patients with autoimmune inflammation

Abstract

Introduction: Currently, the theory of the autoimmune nature of sarcoidosis is increasingly attracting attention. However, there are no clear criteria for autoimmune inflammation in this granulomatous disease, which makes it possible to determine the management tactics of patients with pulmonary sarcoidosis.Materials and methods: In 2017–2019 a prospective comparative study was conducted with the inclusion of 187 people: group I (n = 114) — patients with pulmonary sarcoidosis; control group — healthy individuals (n = 73). Triggers were identified according to the questionnaire “Autoimmune syndrome induced by adjuvants”. Autoantibody levels in the blood were determined using enzyme immunoassay. Peripheral blood B-lymphocytes were examined using flow cytofluorometry. Statistical analysis was carried out using Statistica 10.0 by parametric and nonparametric statistical methods, differences or correlation indicators were considered significant at p ≤ 0.05.Results of the study: triggers were significantly often detected in patients with the symptoms of the autoimmune process (88.5 % vs. 50.0 %, p = 0.042). Antibodies to modified citrullinated vimentin (a-MCV) were detected twice as often as in the control group (40.9 % and 25.0%, respectively). The increase in the level of CD5+CD27 B cells — more than 12.45 % and a change in the ratio of “naive” B cells to memory cells of more than 2:1 were diagnostically significant.Conclusion: The criteria for autoimmune inflammation in patients with sarcoidosis is an increase in the level of anti-MCV more than 10 units / ml and the level of CD5+CD27— more than 12.45 % with a change in the ratio of “naive” B cells to memory cells in a ratio of 2:1. This complex has a high diagnostic sensitivity (91.0 %) and specificity (88.0 %).