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Prof Trevor Marshall
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A new paper purports to differentiate "complicated" from "uncomplicated" sarcoidosis.

I am perplexed by the following faults with this study.
First, it is not clear to me exactly what form the "uncomplicated" diseases takes. The NIH ACCESS study found no "uncomplicated" sarcoidosis, no spontaneous remission. As far as I can see, limited followup could well be an issue in this paper's definition . I would appreciate your reading the study and helping me figure this one out. I am currently working hard on my slides for my first presentation on Sarcoidosis in Russia next Thursday.

Second, the test doesn't seem to be very specific - ie, it gives a lot of incorrect answers (see fig 2,3) (and numerically 80% accuracy to distinguish sarc patients vs controls). Is 80% all the accuracy they were looking for???

Their sample size was small - much smaller than the MP cohort.

But the biggest problem is that I can't figure out exactly how the "complicated" and "non-complicated" patient groups were defined and separated. Can somebody help me dig through all the text?

http://www.sciencedaily.com/releases/2012/10/121012102609.htm

http://www.plosone.org/article/info:doi/10.1371/journal.pone.0044818

The PDF version seems easier to read, perhaps.

Thanks,
Trevor
 

lionel forbes
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Basically,because they dont know nothin about sarc.and the mechanisms involved,they are getting mixed up.You know that different patients will have different outcomes,maybe not due to genetic makeup alone; they are getting ahead of themselves,trying to get an insight into lesser questions;probably due to their frustration at knowing zilch about the disease. Regards,

Markt9452
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I believe that the complex form is "neurosarcoidosis".

mpdayxday
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Complicated sarcoidosis cases are defined as
"severe lung dysfunction or cardiac and neurologic involvement (complicated sarcoidosis)"

Uncomplicated means
"remitting (uncomplicated) sarcoidosis"

They offer a more specific diagnostic categorization of complicated cases as "Complicated sarcoidosis is defined as exhibiting either cardiac manifestations (e.g., ventricular arrhythmias) [3], neurologic involvement (e.g., with evidence of hyperdense MRI lesions) [4] or deteriorating lung function (e.g., FVC <50%)."

Last edited on Sat Oct 13th, 2012 08:13 by mpdayxday

SanDiegoJoy
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Markt9452: Neurosarcoidosis is when the Sarcoidosis attacks the nerves, but this occurs in only a very small percentage of Sarc patients (I believe 5% or less). Lung symptoms occur in about 90% of Sarc patients, liver involvement (often subclinical) in about 70%, I think skin involvment around 25%. At least these statistics are what have been reported in the much of the literature.

Prof Trevor Marshall
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Right, and the huge NIH ACCESS study (circa 2000-2003) found zero cases of remission at 2 years among the 215 newly diagnosed cases of sarcoidosis.There really is no "uncomplicated" sarcoidosis.  How short a selective memory can become when you want to forget inconvenient truths (and inconvenient studies).

We did analyze this ACCESS study way back, many years ago. You can still find the analysis online at: http://autoimmunityresearch.org/access-2yr.htm

..Trevor..

wrotek
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Is cathelicidin measured in sarcoidosis ? Would it not be a good supportive marker together with granulomas ?

Last edited on Thu Nov 1st, 2012 04:11 by wrotek

Prof Trevor Marshall
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Only in studies, to this point:

http://www.ncbi.nlm.nih.gov/pubmed/22759465

"Alveolar macrophage cathelicidin deficiency in severe sarcoidosis"

wrotek
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 Is it technically possible to do this relatively cheaply and would it make a significant difference in diagnosis  ?  The study is very recent.

Last edited on Thu Nov 1st, 2012 04:15 by wrotek

Prof Trevor Marshall
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Nope. FDA regulates all testing in the USA, you would have to get the test approved by FDA. Similarly there is a European regulatory body.
 

wrotek
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I thought doctor can do whatever testing he/she feels are necessary. At least if they are not payed by insurance companies.

Prof Trevor Marshall
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Anything leading to a diagnosis is regulated by TPTB.
That's why the 23andme.com DNA tests had to be pulled, results reworded, and reissued...
 

wrotek
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SNiPs Single Nucleotide Polymorphisms ? Interesting topic, I did not know that person to person can vary by 1% of genetic material. How does one SNP can affect one protein function like VDR ?

Movie i watched about snps  https://www.youtube.com/watch?v=1jHXW_3YUDA



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