Sarcoidosis


Also known as:
Last Review Date: March 18th, 2019


Overview

Sarcoidosis is a condition in which inflammartory cells produce nodules called granulomas in multiple organs. Granulomas can develop anywhere in the body, but they commonly affect the lungs, skin, lymph nodes, and eyes. Granulomas change the structure of the tissues aroudn them and, insufficient numbers, can cause inflammation, damage, and symptoms related to that tissue.

The cause of sarcoidosis is not known. The condition is thought to be associated with boh a genetic predisposition and the immune system's reaction to an environmental trigger, such as exposure to a virus, bacteria, allergen, or chemical. Anyone can develop sarcoidosis, but it most frequently occurs in adults of African or Northern European decent who are 20 to 40 years old of age. African Americans are the most affected group in the U.S. The foundation for Sarcoidosis Research states that nearly 2% of the African Amercian population may be affected. Research also suggests a higher rate of disease for women.

Sarcoidosis varies in severity. A person may have the diseaes without knowing it since mild cases cause few, if any, symptoms and the symptoms may be nonspecific. It can present as an acute illness that resolves on its own within a few years (remission) and may or may not recur. Sarcoidosis can also be a chronic disease that continues over time. According to the National Heart Lung and Blood Institute, more than half of those affected will go into remission within 3 years of diagnosis, and two-thirds will be in remission within 10 years.

Most people with sarcoidosis will not experience long-term health effects, but about one-third will have some degree of organ damage. Sarcoidosis can cause blindness in rare cases and can sometimes be fatal, primarily in those with severe lung or heart involvement.
 
Signs and Symptoms
The severity of sarcoidosis and the symptoms a person experiences depend upon the tissues and organs affected. A person may have no symptoms or may have nonspecific findings such as:
  • Fever
  • Fatigue
  • Weight loss
  • Night sweats
  • Loss of appetite
  • Swollen lymph nodes
  • Joint pain
Signs and symptoms associated with specific organs are listed below:

Lungs
The American Lung Association estimates that as many as 90% of those with sarcoidosis will have lung involvement. Lung tissues can stiffen and scar tissue may develop. Symptoms include:
  • Dry cough
  • Wheezing
  • Shortness of breath
  • Chest pain

Skin
Up to 25% of those sarcoidosis have skin problems, including:
  • Sores on or near the cheeks, ears, nose, and eyelids
  • A raised, reddish, bumpy rash on the ankles or shins tha may itch or be tender and warm
  • Discoloured skin
  • Inflammation and nodules around scars

Eyes
  • Blurred vision
  • Sensitivity to light
  • Eye pain and itching
  • Burning and redness
  • Tears
  • Inflammation

Heart
Brain and Nervous System
  • Headaches
  • Weakness
  • Seizures
  • Decreased coordination and tremors

Muscle and Bone
  • Pain
  • Joint stiffness

Sarcoidosis can also cause kidney and liver dysfunction, an enlarged liver or spleen, and swollen salivary glands. Granulomas produce activated vitamin D (1,25-dihydroxyvitamin D), which cause the intestines to absorb more calcium, leading to increased calcium in the blood and urine and the formation of kidney stones. In rare cases, it may cause kidney failure.

 

 








 

Testing for sarcoidosis

The goals of testing are to diagnose sarcoidosis, evaluate its severity, and monitor its course over time.
Testing is also used to distinguish sarcoidosis from conditions with similar symptoms and from conditions that are also associated with the developement of granulomas, such as tuberculosis, and some fungal infections.

Laboratory Tests
Tissue biopsy is the primary test used to confirm a diagnosis of sarcoidosis; characteristic changes in the structure of the tissue can be seen under the microscope. Other laboratory tests are not specific for sarcoidosis, but they are helpful in assessing disease activity, looking for damage to individual organs, and ruling out other diseases that may cause similar problems. Tests that may be useful include:
Non-laboratory Tests
  • Chest X-ray- a common and useful test for detecting lung involvement; in people without symptoms, granulomas may first be discovered when they have an X-ray for another reason.
  • Lung function tests are performed to evaluate lung involvement and its severity. (For more on these, read Johns Hopkins Medicine Health Library: Pulmonary Function Tests.)
  • CT (computed tomography), MRI (magnetic resonance imaging), gallium scan, or other imaging scans can sometimes ordered to help diagnose and evaluate sarcoidosis. (visit Inside Radiology for additional details on these imaging tests.)

Treatment

There is no way to prevent or cure sarcoidosis, but in many cases, it will resolve on its own overtime.
The goals of treatment are to relieve symptoms, decrease inflammation, and to minimize tissue and organ damage. People who have few or mild symptoms may not need treatment, but their condition should be monitored.

Those with moderate to severe symptoms and those at risk for tissue or organ damage are usually treated with corticosteroids such as prednisone. These anti-inflammatory medications may be given orally, topically, or through an inhaler. Long-term use of corticosteroids can cause significant side-effects.

Other medications may include:
  • Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen for pain and inflammation.
  • Methotrexate and other drugs that suppress the immune system for lung, skin or eye involvement.
  • Hydroxychloroquine (an anti-malarial drug) may be useful for skin and nervous system involvement, especially in people who have increased calcium levels.

Most people can be successfully treated, but they may need to take medications for an extended period of time. Rarely, a person may need an organ transplant if the lungs or live have become severely damaged.

On this Site
Tests: ACEAFB TestingBacterial Sputum CultureLiver PanelComplete Blood CountCalciumCSF AnalysisFungal Tests
Conditions: Lung DiseasesFungal InfectionsTuberculosisNontuberculous Mycobacteria

Elsewhere on the Web
FamilyDoctor.org: Sarcoidosis 
American Lung Association: Sarcoidosis
Mayo Clinic: Sarcoidosis 
MedlinePlus Medical Encyclopedia: Sarcoidosis
National Heart Lung and Blood Institute: What Is Sarcoidosis?