Sarcoidosis is a rare, little-known, inflammatory disease that affects many different areas of the body, particularly the lungs and lymph glands. In the United States, only four out of every 10,000 people are diagnosed with this potentially deadly disease.
The symptoms can appear in different forms – abnormal masses or nodules of inflamed tissues known as granulomas form in certain organs of the body, affecting their structure and function.
Sarcoidosis usually occurs between the ages 20 and 50 years with women being affected more than men. Ethnicity is also a factor with sarcoidosis prevalence, with African-Americans, Scandinavians, Germans, Irish, and Puerto Rican natives being more susceptible to the disease.
Causes of Sarcoidosis
The exact causes of sarcoidosis are not known. It is regarded as an autoimmune disease triggered by an abnormal immune response to a combination of factors.
Some experts theorize that it may be triggered by environmental exposure to molds, dust, or certain bacteria and viruses.
Genetics may play a role in sarcoidosis. Researchers believe that a certain gene or genes and family history of sarcoidosis raise risks for the disease, but one defined cause has not been determined.
Symptoms of Sarcoidosis
The symptoms are often vague, seemingly benign, minor, and can often be very similar to other diseases. They also vary depending on the location in the body, which can make the disease difficult to diagnose, and may lie undetected for a long time.
Some common symptoms of possible sarcoidosis are:
· Red, teary eyes, blurry vision
· Swollen, painful joints
· Fatigue
· Persistent dry cough, hoarseness, and shortness of breath
· Tender reddish bumps, rash, sores, or patches on the skin
· Enlarged, tender lymph glands in neck, armpits, and groin
· Enlarged lymph glands in chest and lungs
· Painful hands, feet, or other bony areas due to bone cysts
· Kidney stones
· Enlarged liver
· Night sweats
· Weight loss
· Abnormal heart beat (arrhythmia), inflammation of the covering of the heart (pericarditis), or heart failure
· Nervous system effects – hearing loss, meningitis, seizures, or psychiatric disorders like dementia, depression, psychosis
There is also a variation of sarcoidosis called Lofgren’s syndrome, which can be indicated by fever, enlarged lymph nodes, arthritic symptoms, and erythema nodosum (a rash of reddish-purple bumps on the ankle and shins).
Sarcoidosis symptoms may appear suddenly and range from mild to severe. They may last for a long time or subside quickly. Some sufferers show no outward symptoms at all, while others may have slowly progressing, subtle symptoms that last or recur over a long time span.
Diagnosing Sarcoidosis
Diagnosing this mystery disease can be tricky and confusing because the symptoms can be attributed to other more commonly occurring conditions such as arthritis, fibromyalgia, or chronic fatigue syndrome.
Evaluation may need to be conducted by a team of specialists – pulmonary, cardiology, dermatology, ophthalmology, rheumatology, and neurology sub-specialists, specially trained in the diagnosis and treatment of sarcoidosis.
The best strategy is to use the “Diagnosis of Exclusion” – by testing for and eliminating
other diseases that carry the symptoms.
If symptoms occur in tissues that are hard to biopsy – heart, liver, eyes, joints – a “Presumptive Diagnosis” may be made based on medical history, clinical evidence, and lab testing.
No single diagnostic test can determine sarcoidosis. Even the location of granulomas isn’t definitive, as they are similar to masses found in other diseases. A combination of the following will help to diagnose the disease:
Physical Examination
Your physician will specifically question you about your complaint, symptoms and will conduct a physical exam.
Personal and family medical history
He will take your and your family members’ medical history.
Imaging tests
He may order one or more of the follow imaging tests:
· Chest X-rays to examine cloudiness (pulmonary infiltrates) or swollen lymph nodes (lymphadenopathy)
· Bone X-rays
· HRCT scan (high resolution CT) for a detailed look at lungs and lymph nodes
· MRI
· PET scan
· Pulmonary Function Test (PFT) to measure lung function
· Bronchoscopy to inspect the bronchial tubes and extract tissue for a biopsy
· Surgical (excisional) lymph node biopsy
· Biopsy
Treatment
There’s no definitive cure for sarcoidosis, but in 50% of cases it clears up on its own. Many patients require no treatment if there are no significant signs and symptoms. However, regular monitoring, tests, and examinations will be necessary.
For severe sufferers there are some lifestyle changes and treatment options available to alleviate symptoms, control the disease, and maintain organ functionality.
Lifestyle changes:
· a well-balanced diet with plentiful fruits and vegetables
· avoiding excess calcium and vitamin D
· limiting sun exposure
· adequate hydration with water and fluids
· adequate sleep – 6-8 hours per night
· quitting smoking
· exercising regularly
· managing weight
· regular health check-ups
Medications:
If symptoms are severe or organ function is threatened, medication will be prescribed:
· Corticosteroids – anti-inflammatory drugs, eye drops, and topical creams
· Methotrexate and azathioprine (immune-suppressant drugs)
· Hydroxychloroquine – for skin disease and elevated blood-calcium levels
· Tumor necrosis factor-alpha (TNF-alpha) inhibitors – to treat inflammation
Surgical Options
Surgery is sometimes considered in severe cases, such as organ transplants for severely damaged lungs, heart, or liver.
Prognosis of Sarcoidosis
In many cases, the disease appears briefly and then disappears without the person even being aware. Twenty to thirty percent have some degree of permanent lung damage. For a small number, sarcoidosis is a chronic condition. In some the disease may cause deterioration of the affected organ.
Sarcoidosis is rarely fatal, however, with death usually being the result of complications with the lungs, heart, or brain. Early diagnosis and treatment will often guarantee the best outcomes. At Lung & Sleep Specialists of North Texas, conditions such as sarcoidosis are serious yet very treatable by our providers. Call (817) 594-9993 today, or request an appointment online.
