Highlights of the 9th WASOG Meeting, Athens, Greece June 19-22, 2008
The 9th WASOG Meeting, in association with BAL International Conference, was held in Athens, Greece, June 19-22, 2008. More than 200 international clinicians and scientists delivered lectures and conducted poster discussions on many clinical and basic science aspects of sarcoidosis. From these outstanding presentations I have selected a few that might be of interest to our website readership.
Cause of sarcoidosis
The cause of sarcoidosis remains unknown. Dr. Lee Newman from Denver, USA argued that sarcoidosis should be considered a disease with many causes including bacteria, viruses, organic antigens, and inorganic dusts. Dr Wonder Drake from Nashville, Tennessee told us that the presence of mycobacterial virulence factors, ESAT-6 and katG antigens points toward a mycobaterial etiology. These antigens generate a CD4+ T cells immune response in the context of DRN1*1101 which plays a role the pathogenesis of sarcoidosis. Dr. Anna Dubaniewicz from Gdansk, Poland forwarded an interesting hypothesis that genetically different individuals may manifest a different immune response to the same antigen, perhaps. An undefined mycobacterium may produce two dissimilar syndromes, sarcoidosis or tuberculosis. Her studies on mycobacterial heat shock proteins are designed to explore relationship between sarcoidosis and tuberculosis.
Fatigue related to sarcoidosis
Dr. Marjolein Drent from Maastricht, The Netherlands and Dr. Robert Baughman from Cincinnati, Ohio tackled the difficult problem of fatigue in sarcoidosis; Dr. Baughman emphasized that antidepressants should be used in controlling symptoms of fatigue, whereas, Dr. Drent suggested that it would be more productive to treat the cause. Both speakers, however, agreed that fatigue is an important cause of disability in these patients and required more attention and understanding. Marjon Elfferich and her colleagues from Maastricht pointed out that the patients with fatigue and sarcoidosis have cognitive inefficiency which usually remains unrecognized.
Extrathoracic sarcoidosis
Dr. Marc Judson from Charleston, South Carolina explored the mystery of three difficult problems of upper airway involvement, lupus pernio, and myocardial sarcoidosis. In his experience sarcoidosis of the heart required no treatment if the patient has no irregular heart rate, arrhythmia or electro-cardiographic abnormalities. Dr. Teruo Tachibana from Osaka, Japan described his experience with liver disease in the Japanese sarcoidosis patients. He found that peritoneoscopy and abdominal CT were helpful in establishing the diagnosis. The liver involvement responded nicely to treatment with cortico-steroids.
Genetic prognostic factors
Dr. Johan Grunewald told us that the patients with Lofgren’s syndrome who are HLA-DRB1*03 patients have much better prognosis then the patients with Lofgren’s syndrome who are HLA-DRB1*03 negative. More than 90% of the patient with DRB1*03 spontaneously subside as opposed to only 50% of those with HLA-DRB1*03 negative genotype. Petal Wijnen, from the department of Clinical chemistry of the University Maastricht found a relation with the presence or absence of TNF alpha polymorphisms. Patients without a TNF alpha -308 polymorphism have an almost threefold higher risk of progressing to chest X-ray stage IV.
Miscellaneous
There were many presentations that pointed out the similarities and coexistence of sarcoidosis with autoimmune disease and cancer. It was important to establish the diagnosis of sarcoidosis based on the consistent biopsy in an individual with a multisystem presentation.
Treatment
Most of the speakers agreed that the best treatment for sarcoidosis was the judicious use of the available including prednisone, methotrexate, hydroxychloroquine, azathioprine, and infliximab.
Om P. Sharma, FRCP
Past-President WASOG
Los Angeles, USA