BACKGROUND Sarcoidosis is a multi-system disorder with an increasing propensity to present in older patients. Diagnostic uncertainty is common and understandable given the higher prevalence of co-morbidities in older patients and broad differential for multi-system clinical presentations. Excluding malignancy and infection with a high degree of certainty is challenging and may require repeated confirmatory investigation where the diagnosis remains in doubt. SUMMARY OF MAIN FINDINGS There are a paucity of studies examining late-onset sarcoidosis. Female predominance, pulmonary, ocular, skin and systemic symptoms are common, while more classical presentations such as Lofgren's syndrome are uncommon. Positivity rates of biopsies vary between studies; however, targeted biopsies of accessible sites with organ involvement are the most successful. Therapeutic management is directed at reducing inflammation, and thereby reducing symptom burden, improving quality of life and avoiding progression of organ damage. While most older patients will require corticosteroid therapy, they are also more prone to developing adverse effects. Most older patients will experience a clinical remission; however, the risk of developing chronic sarcoidosis and organ damage is higher compared with younger counterparts. Patients with evidence of pulmonary fibrosis and pulmonary hypertension are at particular risk. IMPACT ON CLINICAL PRACTICE Health care providers who care for older adults should be aware of the increasing prevalence of late-onset sarcoidosis and consider the diagnosis in those who present with otherwise unexplained systemic symptoms, thoracic abnormalities on imaging and/or evidence of other organ involvement. Earlier diagnosis and therapeutic intervention to halt the development of pulmonary fibrosis and pulmonary hypertension and monitoring for treatment-related adverse effects will confer a mortality benefit.

中文翻译：

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老年人结节病：诊断挑战和治疗考虑。

背景 结节病是一种多系统疾病，在老年患者中发病率增加。鉴于老年患者合并症的患病率较高以及多系统临床表现的广泛差异，诊断不确定性是常见且可以理解的。高度确定地排除恶性肿瘤和感染具有挑战性，并且在诊断仍然存疑的情况下可能需要反复进行确认性调查。主要发现总结 缺乏检查迟发性结节病的研究。女性为主，肺部、眼部、皮肤和全身症状很常见，而洛夫格伦综合征等更典型的表现并不常见。活检的阳性率因研究而异；然而，对器官受累的可及部位进行靶向活检是最成功的。治疗管理旨在减少炎症，从而减轻症状负担，改善生活质量并避免器官损伤的进展。虽然大多数老年患者需要皮质类固醇治疗，但他们也更容易出现不良反应。大多数老年患者会出现临床缓解；然而，与年轻的同龄人相比，患慢性结节病和器官损伤的风险更高。有肺纤维化和肺动脉高压证据的患者尤其危险。对临床实践的影响 照顾老年人的卫生保健提供者应该意识到迟发性结节病的患病率正在增加，并考虑对那些出现其他无法解释的全身症状的人进行诊断，影像学上的胸部异常和/或其他器官受累的证据。早期诊断和治疗干预以阻止肺纤维化和肺动脉高压的发展以及监测与治疗相关的不良反应将带来死亡率益处。