Sarcoidosis

1 What is Sarcoidosis?

Sarcoidosis is a condition characterized by the growth of tiny collections of granulomas (inflammatory cells). In different parts of the body. Most often it occurs in lungs, lymph nodes eyes and skin. 

Generally, it is believed to be a result of the attack of body’s own immune system to an unknown substance. People heal very fast with little modest treatment but there is no cure for sarcoidosis. Sarcoidosis fades away on its own but in other cases it may last for years.

2 Symptoms

Depending on which organ and organ system is affected, signs and symptoms of sarcoidosis vary accordingly. The symptoms caused by sarcoidosis last for years and some symptoms appear and disappear suddenly. Many people with sarcoidosis show no symptoms. 

General symptoms of sarcoidosis include: 

Specific symptoms are directed towards the organ affected. They are: 

  • Lungs- persistent dry cough, shortness of breath, wheezing and chest pain
  • Skin- reddish-purple bumps usually located on shin or ankle which may be warm and tender to tough, disfiguring sores on the nose, cheeks and ears, areas of uneven color and nodules (growth under the skin) is seen particularly around scars or tattoos. 
  • Eye- blurred vision, eye pain, severe redness and sensitivity to light.
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3 Causes

The specific cause of sarcoidosis is not yet established. Genetic predisposition may play an important role in development of this disease. 

Some triggers can turn genetic predisposition into sarcoidosis (the actual disease) are: 

  • bacteria,
  • viruses,
  • dust,
  • chemicals.

These triggers can cause over-reaction of the immune system and immune cells begin to collect in a pattern of inflammation called granulomas. If granulomas build up in an organ they interfere with the normal function of that organ and can even cause organ failure.

4 Making a Diagnosis

Sarcoidosis is a difficult disease to diagnose because of few signs and symptoms in its early stages. Diagnosis will start with a physical examination which includes close examination of skin lesions, checking for swollen lymph nodes, auscultating the heart and lungs for abnormal sounds with the help of a stethoscope. 

Some additional diagnostic procedures are:

  • X-ray of the chest to examine any lung damage or enlarge lymph nodes.
  • CT scan for a 3-dimensinal view.
  • MRI is used to examine central nervous system.
  • Blood test to assess the function of kidney and liver. 
  • Lung function tests to measure the capacity of lung and perfusion (blood flow of lungs) rate.
  • Eye examination to check for vision problems.

Most often, doctors will take a tissue sample (biopsy) from the skin lesions and even from the lungs and lymph nodes if required.

5 Treatment

There is no cure for sarcoidosis but in half of the cases it fades away on its own without any treatment. No specific treatment is required if there are no significant signs and symptoms. In case of severe symptoms, treatment is given as follows: 

Medications- Corticosteroids are anti-inflammatory drugs which are usually the first line treatment for sarcoidosis. In some cases, topical application of corticosteroids in the form of ointment on the skin or in the form of drops to the eyes is recommended. 

Immunosuppressants such as Methotrexate and Azathioprine reduce inflammation by suppressing the immune system. Hydroxychloroquine (Plaquenil) may be helpful for the skin disease and elevated calcium levels in the blood. 

TNF-alpha inhibitors are usually given to treat inflammation caused by rheumatoid arthritis. They can also be helpful in treating sarcoidosis that did not respond to other treatments. 

Surgery- organ transplant may be considered if sarcoidosis has severely damaged the lungs, heart or liver.

6 Prevention

To prevent the disease one must be aware of the causes, though sarcoidosis cannot be linked to a specific cause, some steps can be taken to prevent sarcoidosis. They include: 

  • quitting smoking,
  • limiting alcohol consumption,
  • avoiding exposure to toxic inhalants which provoke the development of sarcoidosis.

Regular check-up and consultation with the family doctor can prevent this disease.

7 Lifestyle and Coping

Lifestyle modifications are necessary in order to cope with the side effects of sarcoidosis.

Although sarcoidosis usually goes away by itself within 2 years, some people’s lives are affected forever and altered by the disease.

The disfiguring scars on the face leads to the development of anxiety and depression.

Seeking help of a counselor and participating in sarcoidosis support group is always helpful.

8 Risks and Complications

There are several risks and complications associated with sarcoidosis.

While any person can develop sarcoidosis some risk factors contribute to a greater chance of sarcoidosis development. They are:

  • Age- sarcoidosis often affects people between the ages of 20 to 40 years. 
  • Sex- Women are more likely to develop sarcoidosis. 
  • Race- African-American have a higher chance of sarcoidosis development than white Americans. Sarcoidosis is more severe and causes life-threatening lung problems in African-Americans. 
  • Family history- If someone in the family was affected with sarcoidosis, then the other family members are also likely to develop this disease. 

Complications are different depending upon the organ affected. In case of:

  • Lungs- permanent scarring may occur if there was untreated pulmonary sarcoidosis making it difficult to breath. 
  • Eyes- complete blindness can be a result of inflammation in the optic nerve. Rarely sarcoidosis is the cause of glaucoma and cataract. 
  • Kidneys- Sarcoidosis may lead to accumulation of calcium deposits in the kidney and can cause kidney failure. 
  • Heart-granulomas in the heart can cause disturbances in heart rhythm. Sometimes it may also lead to heart failure
  • Nervous System- A small number of people with sarcoidosis are develop problems related to central nervous system. Paralysis may occur due to granulomatous deposits in the cranial nerves.
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