Elderly-Onset Sarcoidosis and the Influence of Age on Clinical Phenotypes: A Multicentre Analysis from the SARCOGEAS Registry

Background/Objectives: To determine the proportion of elderly-onset sarcoidosis (EOS) and to assess the influence of age at diagnosis on pulmonary and extrapulmonary manifestations. Methods: Retrospective multicentre study using the Spanish SARCOGEAS registry, including adults with sarcoidosis diagnosed across 36 hospitals. EOS was defined as diagnosis at ≥65 years. Associations between clinical features and age were assessed using multivariable logistic and linear regression models, including sex-stratified analyses. Results: Among 2187 patients (mean age 48.6 ± 15.2 years, 61.36% women), 358 (16.37%) had EOS. In multivariable analyses, female sex (OR 1.86; β +5.02 years), White ethnicity (OR 5.43; β +4.85 years), and renal involvement (OR 2.29; β +6.86 years) were independently associated with EOS and older age at diagnosis, whereas cutaneous (OR 0.49; β −3.50 years), articular or bone (OR 0.37; β −3.10 years), and neurological involvement (OR 0.49; β −2.47 years) were associated with non-EOS and younger age at diagnosis. Exploratory sex-stratified analyses suggested additional patterns: in women, calcium metabolism abnormalities were associated with EOS (OR 1.74) and older age at diagnosis (β +4.91 years), and ear–nose–throat involvement was associated with older age at diagnosis (β +5.74 years). Regarding pulmonary involvement, CT-based Scadding stage II was associated with younger age at diagnosis (β −3.75 years) in women and CT-based Scadding stage IV with older age at diagnosis (β +6.57 years) in men. Conclusions: EOS accounted for 16.37% of sarcoidosis cases. Older age at diagnosis was associated with specific patterns of organ involvement, which changed gradually across the age spectrum, some of them differing by sex in exploratory analyses. Further studies are needed to confirm these findings.