Abstract
Sarcoidosis is a chronic inflammatory illness and small-fiber neuropathy (SFN) is one of the disabling and often chronic manifestations of the disease. SFN presents with peripheral pain and symptoms of autonomic dysfunction. The character of the pain can be burning or shooting. Besides, allodynia and hyperesthesia can exist. Diagnosis is usually made on the basis of clinical features, in combination with abnormal specialized tests. The aim of treatment is often to reduce pain; however, total pain relieve is seldom achieved. The role of TNF-α in the pathogenesis of SFN in sarcoidosis appears interesting to explore. Novel therapeutic agents such as ARA 290, a nonhematopoietic erythropoietin analogue with potent anti-inflammatory and tissue protective properties, are interesting to explore in the treatment of SFN in sarcoidosis.
Highlights
Sarcoidosis has been known for more than 100 years and has been first described by the dermatologist Hutchinson and several years later by two other dermatologists, Besnier and Boeck
Granuloma formation is regulated by a complex interaction between T-helper lymphocytes and macrophages, in which cytokines such as tumor necrosis factor (TNF)-α play an important role
Spontaneous remission usually occurs within two years, while chronic sarcoidosis mostly has an insidious onset with often relapses, resolution being less likely
Summary
Sarcoidosis has been known for more than 100 years and has been first described by the dermatologist Hutchinson and several years later by two other dermatologists, Besnier and Boeck. The acute stage of disease usually presents itself with erythema nodosum, arthritis, fever, and fatigue with a good prognosis. Spontaneous remission usually occurs within two years, while chronic sarcoidosis mostly has an insidious onset with often relapses, resolution being less likely. Development of lung fibrosis, cardiac sarcoidosis, and neurosarcoidosis is related to worse prognosis. Pain and fatigue are important symptoms, even when sarcoidosis is clinically in remission fatigue and pain may persist and become a chronic complaint. These complaints often result in a severe reduction in quality of life. A lot of research has been done, the exact mechanism behind this “postsarcoidosis chronic fatigue syndrome” remains unsolved. It has been shown that pain in patients with sarcoidosis is often related to neuropathy of small fibers of the peripheral nervous system [4,5,6,7]
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