What Is Sarcoidosis?
Sarcoidosis is an inflammatory disease in which granulomas, or clumps of inflammatory cells, form in various organs. This causes organ inflammation. Sarcoidosis may be triggered by your body’s immune system responding to foreign substances, such as viruses, bacteria, or chemicals.
The areas of the body commonly affected by sarcoidosis include:
- lymph nodes
Causes and Risk Factors
What Causes Sarcoidosis?The exact cause of sarcoidosis is unknown. However, gender, race, and genetics can increase the risk of developing the condition:
- Sarcoidosis is more common in women than in men.
- People of African-American descent are more likely to develop the condition.
- People with a family history of sarcoidosis have a significantly higher risk of getting the disease.
Sarcoidosis rarely occurs in children. Symptoms usually appear in people between the ages of 20 and 40. Symptoms
What Are the Symptoms of Sarcoidosis?
Some people with sarcoidosis don’t have any symptoms. However, general symptoms may include:
- weight loss
- joint pain
- dry mouth
- abdominal swelling
Symptoms vary depending on the part of your body that’s affected by the disease. Sarcoidosis can occur in any organ, but it most commonly affects the lungs. Lung symptoms can include:
- a dry cough
- shortness of breath
- chest pain around your breastbone
Skin symptoms can include:
- skin rashes
- skin sores
- hair loss
- raised scars
Nervous system symptoms can include:
- hearing loss
Eye symptoms can include:
- dry eyes
- itchy eyes
- eye pain
- vision loss
- a burning sensation in your eyes
- a discharge from your eyes
How Is Sarcoidosis Diagnosed?
It can be difficult to diagnose sarcoidosis. Symptoms can be similar to those of other diseases, such as arthritis or cancer. Your doctor will run a variety of tests to make a diagnosis.
Your doctor will first perform a physical examination to:
- check for skin bumps or a rash
- look for swollen lymph nodes
- listen to your heart and lungs
- check for an enlarged liver or spleen
Based on the findings, your doctor may order additional diagnostic tests:
- A chest X-ray can be used to check for granulomas and swollen lymph nodes.
- A chest CT scan is an imaging test that takes cross-sectional pictures of your chest.
- A lung function test can help determine whether your lung capacity has become affected.
- A biopsy involves taking a sample of tissue that can be checked for granulomas.
Your doctor may also order blood tests to check your kidney and liver function.
Sarcoidosis is an inflammatory disease that affects multiple organs in the body, but mostly the lungs and lymph glands. In people with sarcoidosis, abnormal masses or nodules (called granulomas) consisting of inflamed tissues form in certain organs of the body. These granulomas may alter the normal structure and possibly the function of the affected organ(s).
What Are the Symptoms of Sarcoidosis?
The symptoms of sarcoidosis can vary greatly, depending on which organs are involved. Most patients initially complain of a persistent drycough, fatigue, and shortness of breath. Other symptoms may include:
- Tender reddish bumps or patches on the skin.
- Red and teary eyes or blurred vision.
- Swollen and painful joints.
- Enlarged and tender lymph glands in the neck, armpits, and groin.
- Enlarged lymph glands in the chest and around the lungs.
- Hoarse voice.
- Pain in the hands, feet, or other bony areas due to the formation of cysts (an abnormal sac-like growth) in bones.
- Kidney stone formation.
- Enlarged liver.
- Development of abnormal or missed heart beats (arrhythmias), inflammation of the covering of the heart (pericarditis), or heart failure.
- Nervous system effects, including hearing loss, meningitis, seizures, or psychiatric disorders (for example, dementia, depression, psychosis).In some people, symptoms may begin suddenly and/or severely and subside in a short period of time. Others may have no outward symptoms at all even though organs are affected. Still others may have symptoms that appear slowly and subtly, but which last or recur over a long time span.
Who Gets Sarcoidosis?Sarcoidosis most often occurs between 20 and 40 years of age, with women being diagnosed more frequently than men. The disease is 10 to 17 times more common in African-Americans than in Caucasians. People of Scandinavian, German, Irish, or Puerto Rican origin are also more prone to the disease. It is estimated that up to four in 10,000 people in the U.S. have sarcoidosis.
What Causes Sarcoidosis?The exact cause of sarcoidosis is not known. It is a type of autoimmune disease associated with an abnormal immune response, but what triggers this response is uncertain. How sarcoidosis spreads from one part of the body to another is still being studied.There is no single way to diagnose sarcoidosis, since all the symptoms and laboratory results can occur in other diseases. For this reason, your doctor will carefully review your medical history and examine you to determine if you have sarcoidosis. The main tools your doctor will use to diagnose sarcoidosis include:
- Chest X-rays to look for cloudiness (pulmonary infiltrates) or swollen lymph nodes(lymphadenopathy).
- CT scan to provide an even more detailed look at the lungs and lymph nodes than provided by a chest X-ray.
- Pulmonary function (breathing) tests to measure how well the lungs are working.
- Bronchoscopy to inspect the bronchial tubes and to extract a biopsy(a small tissue sample) to look for granulomas and to obtain material to rule out infection. Bronchoscopy involves passing a small tube (bronchoscope) down the trachea (windpipe) and into the bronchial tubes (airways) of the lungs.Sarcoidosis is a rare condition that causes small patches of red and swollen tissue, called granulomas, to develop in the organs of the body. It usually affects the lungs and skin.The symptoms of sarcoidosis depend on which organs are affected, but typically include:There’s no cure for sarcoidosis, but the condition often improves without treatment within a few months or years. The symptoms aren’t usually severe and don’t tend to affect everyday life.
Symptoms of sarcoidosisIt’s impossible to predict how sarcoidosis will affect a person, as the condition can affect any organ and the symptoms vary widely depending on which organs are involved. Some people don’t have any symptoms at all, and the condition is diagnosed after an X-ray carried out for another reason.Sarcoidosis most often affects the lungs, skin and/or lymph nodes (glands). Some of the typical symptoms are listed below, although someone with sarcoidosis will probably only have a few of these.The lungs are affected in about 90% of people with sarcoidosis. This is known as pulmonary sarcoidosis.
Skin symptomsThe skin is affected in about 25% of people with sarcoidosis.
Other symptomsIf other organs are affected, you may also have some of the following symptoms:
Causes of sarcoidosisThe body’s immune system normally fights off infections by releasing white blood cells into the blood to isolate and destroy the germs. This results in inflammation (swelling and redness) of the body tissues in that area. The immune system responds like this to anything in the blood it doesn’t recognise, and dies down when the infection has been cleared.There are many similar conditions, such as rheumatoid arthritis andlupus, that are caused by the body attacking its own tissues. These are collectively known as autoimmune conditions.It’s possible that some environmental factor triggers the condition in people who are already genetically susceptible to it.
Who’s affectedSarcoidosis can affect people of any age, but usually starts in young adults aged between 20 and 40. It’s rare in childhood.
Diagnosing sarcoidosisA number of different tests may be carried out to diagnose sarcoidosis, depending on which organs are affected.In some cases, doctors may want to examine the inside of your lungs using a long, thin, flexible tube with a light source and a camera at one end (endoscope) that’s passed down your throat. A small sample of lung tissue may also be removed during this test so it can be studied under a microscope. This is known as a biopsy.
If doctors think you may have sarcoidosis affecting other organs – such as the skin, heart or eyes – scans or examinations of these areas will usually be carried out.
How Is Sarcoidosis Treated?
There is no cure for sarcoidosis, but the disease may get better on its own over time. Many people with sarcoidosis have mild symptoms and do not require any treatment. Treatment, when it is needed, is given to reduce symptoms and to maintain the proper working order of the affected organs.
Treatments generally fall into two categories — maintenance of good health practices and drug treatment. Good health practices include:
Drug treatments are used to relieve symptoms and reduce the inflammation of the affected tissues. The oral corticosteroid prednisoneis the most commonly used treatment. Fatigue and persistent cough are usually improved with steroid treatment. If steroids are prescribed, you should see your doctor at regular intervals so that he or she can monitor the disease and the side effects of treatment. Other treatment options include methotrexate(Otrexup, Rheumatrex), hydroxychloroquine(Plaquenil), and other drugs.
What Can Happen As the Disease Progresses?
In many people with sarcoidosis, the disease appears briefly and then disappears without the person even knowing they have the disease. Twenty percent to 30% of people have some permanent lung damage. For a small number of people, sarcoidosis is a chronic condition. In some people, the disease may result in the deterioration of the affected organ. Rarely, sarcoidosis can be fatal. Death usually is the result of complications with the lungs, heart, or brain.
There’s no cure for sarcoidosis. However, symptoms often improve without treatment. Your doctor may prescribe medications if your inflammation is severe. These can include corticosteroids or anti-rejection medications, which can both help reduce inflammation.
Treatment is also more likely if the disease affects your:
- nervous system
The length of any treatment will vary. Some people take medication for one to two years. Other people may need to be on medication for much longer.
What Are the Potential Complications of Sarcoidosis?Most people who are diagnosed with sarcoidosis don’t experience complications. However, sarcoidosis can become a chronic, or long-term, condition. Other potential complications may include:
- lung infection
- cataracts, which is characterized by a clouding of the lens of your eye
- glaucoma, which is a group of eye diseases that can cause blindness
- kidney failure
- abnormal heart beat
- facial paralysis
- infertility or difficulty conceiving
In rare cases, sarcoidosis causes severe heart and lung damage. If this occurs, you may need an organ transplant.
It’s important to contact your doctor if you have:
- breathing difficulties
- heart palpitations, which occur when the heart is beating too fast or too slow
- changes in your vision or loss of vision
- eye pain
- sensitivity to light
- facial numbness
These can be signs of dangerous complications.
Your doctor may recommend that you see an optometrist because this disease can affect your eyes without causing immediate symptoms. Outlook
What Is the Outlook for Someone with Sarcoidosis?The outlook is generally good for people with sarcoidosis. Many people live relatively healthy, active lives. Symptoms often improve with or without treatment in about two years.
In some cases, however, sarcoidosis can become a long-term condition. If you have trouble coping, you can talk to a psychotherapist or join a sarcoidosis support group.
How sarcoidosis is treated
Most people with sarcoidosis don’t need treatment as the condition often goes away on its own, usually within a few months or years.
Simple lifestyle changes and over-the-counter painkillers (such asparacetamol or ibuprofen) are often all that’s needed to control the pain of any flare-ups. See living with sarcoidosis (below) for lifestyle advice.
Doctors will monitor your condition to check if it’s getting any better or worse without treatment. This can be done with regular X-rays, breathing tests and blood tests.
If treatment is recommended, prednisolone steroid tablets are usually used.
This medication is the most effective treatment for sarcoidosis, helping to relieve symptoms and prevent damage to affected organs by reducing inflammation and preventing scarring.
However, steroid medication can cause unpleasant side effects such as weight gain and mood swings if taken in high doses. Other side effects, such as weakening of the bones (osteoporosis), can also develop if it’s taken for a long time. Therefore, this medication is only used when necessary.
You may initially be given a high dose of steroid medication for a short period of time, before switching to a low dose for the months or years that follow. Your condition will be monitored during this time to see how well the treatment is working.
In some cases, taking calcium or vitamin D supplements can help reduce the risk of osteoporosis caused by long-term use of steroid medication. However, you should only take these if advised by your doctor. Some people with sarcoidosis may have an increased risk of developing complications, including kidney stones, while taking steroid medication.
Alternative medications may sometimes be used if steroids aren’t enough or there are concerns about side effects. In these cases, a type of medication called an immunosuppressant might be recommended. These medications may help to improve your symptoms by reducing the activity of your immune system.
Living with sarcoidosis
The Sarcoidosis Charity recommends the following lifestyle measures if you have sarcoidosis:
- stop smoking, if you smoke
- avoid exposure to dust, chemicals, fumes and toxic gases
- eat a healthy balanced diet
- drink plenty of water
- get plenty of exercise and sleep