THE LATE FOLLOW-UP OF CHRONIC SARCOID PATIENTS PREVIOUSLY TREATED WITH CORTICOSTEROIDS

Aim of the study: The aim of the study was to evaluate, in a white pop ulation with chronic sarcoidosis, the rate and pattern of relapses, th e correlated factors, and the course of disease after prednisone withd rawal. Methods: We have retrospectively examined the charts of 702 con secutive patients with histologically proven sarcoidosis, first seen i n the Milan Sarcoidosis Clinic in the period October 1978 -October 199 4. 239 patients required corticosteroid therapy; in 82, it was possibl e to discontinue prednisone therapy and to have a follow-up of at leas t 18 months after withdrawal. Results: A relapse, requiring a new cour se of steroids, was observed in 30 (36.6%) of the 82 patients (R group ). The other 52 patients (No-R group) did not relapse during a mean fo llow-up of 36.8 +/- 24.8 months (range 18-125). There were no relapses after 3 asymptomatic years of prednisone withdrawal, Extrapulmonary s arcoidosis was a reason for giving therapy in 46.6% of patients in the R group, vs 23.0% in the No-R group (P < 0.05). The first course of t herapy lasted 22 months [median time; i.q. 11.5 to 34.5] in R group vs 26 months [i.q. 18 to 41] in No-R group (P > 0.05). The mean daily pr ednisone dose was higher in the R group: 17 mg [median value; i.q. 8.9 to 23.2] vs 10.6 mg [i.q. 8.1 to 13.8] in the No-R group (p < 0.05). Logistic regression confirmed the prognostic significance of mean dail y prednisone dose and of extrapulmonary sarcoidosis at presentation (P < 0.01). A mild sarcoid activity at the time of withdrawal was still present in 51.9% of patients who did not relapse, and in 66.7% of pati ents who relapsed (p > 0.05). Relapse in the first year after withdraw al of prednisone therapy occurred in twenty-five of the 30 patients. T he pattern of relapse was different from the initial manifestation in 5. Nine of the 30 patients could ultimately be weaned successfully fro m prednisone. Conclusion: Relapses occurred in 36.6% of cases, and the ir pattern was the same as the initial manifestation in the majority o f cases, A mild sarcoid activity at the time of withdrawal is not a re ason for continuing steroids when the disease is abating. In our white population severe irreversible pulmonary impairment is rare, and even patients requiring chronic therapy need low prednisone dosage, usuall y around 10 mg daily, to control the disease in the late course.