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Unraveling the Mystery of Sarcoidosis

© Lou Robinson

The Statement on Sarcoidosis of the World Association of Sarcoidosis and Other Granulomatous Disorders (WASOG) reports that scientists have conducted a significant amount of research on the clinical course, pathology, and immunological aspects of sarcoidosis. Less is known about the epidemiology and genetic factors.

For those of us coping on a daily basis with the symptoms of the disease and the side effects of medications, research efforts seem not to be enough. Sometimes it is useful to understand where we have been to better appreciate where we are. This brief review of the history of sarcoidosis research illustrates that wide-scale research efforts are fairly new.

While Jonathan Hutchinson, an English physician, is credited with documenting the condition that later became known as sarcoidosis, we can imagine that the mystery has been with us since the beginning of time. WASOG describes sarcoidosis are a "systemic granulomatous disease that primarily affects the lung and lymphatic systems." We can thank scientists for getting us from Hutchinson's observations in 1877 of "multiple, raised, purplish cutaneous patches on the hands and feet..." thought initially to be attributed to gout, and later to represent " a form of skin disease," to WASOG's definition 122 years later.

Caesar Boeck, the nephew of a Norwegian dermatologist, Carl Boeck, who first illustrated sarcoid lesions in sailors, first used the term 'sarkoid" in an 1899 report describing skin lesions that resembled benign sarcoma. But, it was his subsequent research and publications that gradually revealed the systemic nature of the disorder. Boeck, along with other dermatologists and scientists from other specialties and parts of the world, including France, Germany, Denmark, and Sweden, made their discoveries known in the late 19th and early 20th Centuries.

The mid-20th Century ushered in the age of steroid treatment for sarcoidosis, followed by 30 years of research on its effectiveness in treating pulmonary sarcoidosis. This was made possible by the development of the radiographic staging system, which helped to account for the spontaneous remissions often observed in early stages of some of the syndromes. The invention of fiberoptic bronchoscopy in the 1970's allowed for the diagnosis of sarcoidosis to be confirmed.

Carl Boeck attempted the first international collaboration in the late 1800's when he sent his drawings of the lesions of Norwegian sailors to Hutchinson, who failed to publish them. It was not until 1958 that the first International Meeting was held, with very poor attendance. Five years later, an International Committee on Sarcoidosis was formed, resulting in increased collaboration, research, and publication. A Medline search reveals 6500 publications related to sarcoidosis since 1965. The International Committee began publication of the Sarcoidosis Journal in 1984, furthering the dissemination of ideas and research related to sarcoidosis. WASOG was formed in 1987 and published the Statement on Sarcoidosis in 1999. It's 7th Congress is scheduled for June 2002 in Sweden.

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