From the Guidelines
High ACE levels in patients with sarcoidosis are usually associated with more aggressive disease and multiple-organ involvement. This is based on the most recent evidence from the european position paper on rhinosinusitis and nasal polyps 2020 1. The study highlights that serum ACE is the most widely used laboratory test for the investigation of sarcoidosis and that elevated serum levels of ACE are usually associated with more severe disease.
Key Points to Consider
- High ACE levels are not exclusive to sarcoidosis and can be seen in other conditions such as granulomatous diseases, liver diseases, and hyperthyroidism 1.
- A comprehensive evaluation including medical history, physical examination, chest X-ray, and additional laboratory tests is necessary for accurate diagnosis.
- ACE levels alone are not sufficient for diagnosing or ruling out sarcoidosis, as they can be elevated in up to 60% of sarcoidosis cases but can also be normal in active disease.
- The american thoracic society clinical practice guideline also supports the use of ACE levels as a diagnostic tool, but emphasizes the importance of interpreting them in the context of the overall clinical picture 1.
Implications of High ACE Levels
- Elevated ACE levels can indicate a more aggressive disease course and multiple-organ involvement in patients with sarcoidosis 1.
- It is essential to consider alternative diagnoses and to evaluate the patient's overall clinical picture when encountering high ACE levels.
- The use of ACE levels as a diagnostic tool should be guided by the most recent and highest quality evidence, which currently suggests that they can be a helpful but not definitive indicator of sarcoidosis 1.
From the Research
Implications of High Angiotensin-Converting Enzyme (ACE) Levels in Sarcoidosis
- High ACE levels are often associated with active sarcoidosis, as confirmed by studies 2, 3, 4, 5, 6
- Elevated ACE levels can be used as a diagnostic marker for sarcoidosis, particularly when distinguishing it from other respiratory diseases 2
- The level of ACE activity can also serve as an indicator of disease activity and response to treatment, with decreases in ACE levels often corresponding to improvement in clinical symptoms and radiographic findings 2, 3, 4
- However, ACE levels may not always be a reliable monitor of disease activity, especially in patients who have achieved a stable state or are on alternate-day corticosteroid treatment 4
- Elevated ACE levels after cessation of treatment may precede or parallel a relapse of the disease 4
- Other markers, such as serum chitotriosidase, may also be useful in monitoring disease activity and prognosis in sarcoidosis patients 6
- Treatment with corticosteroids, such as prednisone, can effectively reduce ACE levels and improve clinical symptoms 2, 5
- Alternative treatments, such as ketoconazole, may also be effective in controlling hypercalcemia associated with sarcoidosis, although they may not necessarily reduce ACE levels 5