Sarcoidosis manifestations and exposure

Sarcoidosis is a systemic granulomatous disease of unknown origin that may affect virtually every organ. Most likely, an unidentified trigger stimulates an immune response in genetically predisposed individuals. Because of its pulmonary predominance, inhaled triggers may be of pivotal importance for the phenotypical presentation of sarcoidosis. However, data concerning the role of occupational exposure for sarcoidosis are conflicting and smoking has been reported as protective in some studies.

We retrospectively analyzed 323 well-characterized patients with proven sarcoidosis for their smoking history, their occupational exposure and organ involvement of sarcoidosis. 143 patients (44%) were female, 98 (30%) indicated former smoking and 42 (13%) were active smokers. Occupation at initial presentation was grouped according to likely exposure (i.e. metal, inorganic and organic dust, biological agents, close human contact).

Smoking correlated with worse lung function and number of packyears of smoking negatively affected FeV1 (r²=0.18, p<0.01), FVC (r²=0.13, p=0.03) and DLCO (r² 0.26, p<0.01) but did not increase likelihood for an extrapulmonary manifestation. Skin and joint involvement were associated with occupational exposure to organic dust (OR _skin 2.71, CI: 1.24-5.80 and OR _joints 2.75, CI: 1.23 – 6.00) or biological agents (OR _skin 5.52, CI 1.76 – 17.79 and OR _joints 4.16, CI 1.23 – 13.2), whereas no association was found with metal, inorganic dust or close human contact.

Our findings indicate that smoking (active and former) correlates both with obstructive and restrictive lung function impairment. Additionally, we found an association between skin and joint involvement with occupations that favor exposure to biological agents or organic dust.

Publication History

Article published online:
09 March 2023