Sarcoidosis diagnosed in the elderly: a case-control study

Background: Studies on sarcoidosis in elderly patients are scarce and none have specifically evaluated patients aged >= 75 at onset. Aim: We aimed to analyse the characteristics of patients with sarcoidosis diagnosed after 75 and to compare them with those of younger patients. Design: Multicenter case-control study comparing elderly-onset sarcoidosis (EOS) with young-onset sarcoidosis (YOS) seen at Lyon University Hospitals between 2006 and 2018. Methods: Using our institutional database, we included 34 patients in the EOS group and compared them with 102 controls from the YOS group in a 1:3 ratio. Demographic characteristics, medical history, clinical presentation, laboratory and imaging findings, sites of biopsies, histological analyses, treatments and outcomes were recorded using a comprehensive questionnaire. Results: There were more Caucasians in the EOS group (94.1% vs. 59.8%; P<0.001), who had significantly more comorbidities (mean, 3.12 vs. 1.1 +/- 1.6; P<0.001). In the EOS group, there was less pulmonary involvement (26.5% vs. 49%; P=0.022), less lymphadenopathy (2.9% vs. 16.7%; P=0.041), no erythema nodosum (0% vs. 12.8%; P=0.029) and no arthralgia (0% vs. 25.5%; P=0.001). Conversely, uveitis was more common in the EOS group (55.9% vs. 20.6%; P<0.001). Pathological confirmation was obtained significantly less frequently in the EOS group (67.7% vs. 85.3%; P=0.023). Corticosteroid-related side effects were significantly more common in the EOS group (100% vs. 75.9%; P=0.030). Conclusion: Epidemiology and clinical presentation of EOS differs from YOS, including more comorbidities and more uveitis. Elderly patients are more prone to corticosteroid side effects.