Rehabilitation programmes in sarcoidosis: amultidisciplinary approach
, E.F.M. Wouters
, R. Gosselink
Dept of Rehabilitation Sciences, Faculty of Kinesiology and Rehabilitation Sciences, Katholieke Universiteit Leuven and Respiratory Rehabilitation, University Hospital Gasthuisberg, Leuven, Belgium.
Dept of Respiratory Medicine, University Hospital Maastricht, Maastricht, The Netherlands.Correspondence: R. Gosselink, Universitair Ziekenhuis Gasthuisberg, Herestraat 49, 3000 Leuven,Belgium. Fax: 32 16347126; E-mail: Rik.Gosselink@uz.kuleuven.ac.be
Patients with sarcoidosis suffer from a broad range of persistent symptoms, such asfatigue, dyspnoea and general weakness . To date, speciﬁc nonpharmacologicaltreatments to reduce the aforementioned symptoms are mostly lacking in themanagement of patients with sarcoidosis. Nevertheless, exercise training has shown toimprove health status, exercise capacity, skeletal muscle function and complaints of fatigue and dyspnoea in patients with chronic pulmonary or cardiac diseases [2, 3]. Thepresent chapter will provide a rationale for nonpharmacological treatments in patientswith sarcoidosis with persistent clinical symptoms.
Although fatigue is clinically difﬁcult to quantify, qualify, and to treat, it has beenwidely accepted as a highly prevalent and disabling clinical feature in patients withsarcoidosis [4–6]. Recently, 73% of the outpatients with sarcoidosis had a score of
22points on the Fatigue Assessment Scale (FAS) , indicating that a majority of thepatients had self-reported complaints of fatigue. Although the determination of the cut-off score is questionable (
the cut-off score was set at percentile 80 of the scoresobtained in two samples of healthy controls), the cross-sectional study of D
 showed that a score of
22 points on the FAS was independent of an impairedpulmonary function, the treatment of prednisone, and of the circulating levels of solubleinterleukin 2 receptor and amyloid A. Other possible underlying causes may, therefore,be responsible for this observed high prevalence of fatigue. In fact, fatigue has beenrelated to muscle dysfunction. Respiratory muscle weakness, as well as skeletal muscleweakness, was positively related to complaints of fatigue [6, 7]. It will, however, bedifﬁcult to ascertain which is the chicken and which is the egg in this situation. Inaddition, the possible role of endocrinological disturbances in the development and/ormaintenance of complaints of fatigue have never been studied in patients withsarcoidosis. Nevertheless, male patients with sarcoidosis appear to have reducedcirculating levels of testosterone , which has been known to be related to complaints of fatigue in other chronic diseases [9, 10].
Eur Respir Mon, 2005, 32, 316–326. Printed in UK - all rights reserved. Copyright ERS Journals Ltd 2005; European Respiratory Monograph;ISSN 1025-448x. ISBN 1-904097-22-7.