The Disease: Sarcoidosis
Sarcoidosis is an illness that causes small nodules, known as granulomas, in different organs of the body. These nodules are caused by inflammation, which is generally a normal response by your immune system when you are exposed to infection, injury, or toxins. However, in this instance, the inflammation is the source of the problem. The most common organ affected is the lungs, although your skin, eyes, kidneys, heart, nervous system, muscles, joints, lymph nodes, testes, liver and spleen can also be affected. Wherever it is located, as the disease progresses, the smaller nodules can join to create larger nodules that can interfere with the way your organs work.
What Causes Sarcoidosis?
We are not sure what causes sarcoidosis, although there are some theories. It is believed that there is a hereditary component, because it can be found in more than one family member. When someone has a predisposition to the illness, and then is exposed to something in the envirionemnt like a chemical or a germ (bacteria or virus), the disease is activitated. While sarcoidosis can be diagnosed at any age, it is most commonly found in men and women between the ages of 20 and 40 years old. It is rarely found in children. The disease is more common in black individuals, and is generally found in a more severe form than in people who are Caucasian.
What are the Symptoms?
Because sarcoidosis can affect different organs, not everyone has the same symptoms. It is also important to remember that some people have none, or only mild symptoms that resolve on their own. However, all symptoms that can be experienced with sarcoidosis are associated with the organs that have granulomas.
The Lungs are the most common place for the illness to present itself. The majority of people who have symptoms experience a cough, shortness of breath, wheezing, and chest pain. The chest pain may be very mild or could be as severe as the pain experienced during a heart attack. In addition to problems with the lungs, some people, especially those 70 years and older, complain of a fever, weight loss, feeling tired and feeling weak.
Skin lesions might be found on the face, neck, arms, legs, belly, or back, and might be anywhere from mild rashes, to deep scars. Usually the worse the skin lesions are, the more severely the other organs will be involved.
Eyes can be affected in many different ways depending on where the inflammation is. If untreated, sarcoidosis can cause glaucoma, cataracts, and even blindness.
Kidneys can also be damaged by granulomas, or because they are having trouble clearing calcium from your blood. It is most likely that kidney problems will only be found during blood and urine tests, which is why regular medical checkups are important.
Heart problems can occur depending on where nodules form. Your heart beats regularly because there is electrical activity that controls the rate and rhythm. If a nodule forms in a place that interferes with the path of the electrical current, the result can be an irregular rhythm, which can be very dangerous. However, the heart can be affected in other ways. Sometimes, if sarcoidosis has caused enough damage in the lungs, the heart will have trouble pumping blood into the blood vessels of the lungs. Over time, this can cause heart failure, which will result in more shortness of breath and weakness.
The Nervous System can also be affected by sarcoidosis. In the late stages of the disease, meningitis (inflammation in the brain) can occur, resulting in impaired brain function, facial weakness and paralysis. If your nerves are involved, you can experience pain, numbness, tingling, or weakness of your arms or legs.
The Joints and Muscles may also have some symptoms from inflammation and swelling. This can include muscle aches, joint pain, swelling and generalized muscle weakness.
The Testes may be involved in the progression of sarcoidosis. If so, it can cause male infertility.
The Spleen plays an important role in the production of blood. If it is affected, you may have blood abnormalities or anemia.
How is Sarcoidosis Diagnosed?
Because sarcoidosis can be present without symptoms, many people are diagnosed while undergoing tests for other reasons. It is very common for something to be found on a routine chest X-ray. However, there is no single test that will confirm the diagnosis of sarcoidosis. It is instead a process of looking for signs that indicate the disease and eliminating other possibilities. For instance, a tuberculosis infection can sometimes look like sarcoidosis. If sarcoidosis is suspected in the lungs, you will probably need a bronchoscopy. During this procedure, a pulmonary doctor will insert a flexible tube into your lungs while you are sedated, and will take a biopsy to be examined by the lab. This is a way to make sure you have a diagnosis of sarcoidosis, and not something else. In fact, any organ that may be involved can also be biopsied to confirm a diagnosis.
Other tests might include specialized X-rays like CT scans, PET scans, or an MRI. Heart problems can be evaluated by an electrocardiogram (EKG), which shows the electrical activity in the heart. Some lab tests may also be helpful in the diagnosis. Abnormal results could include anemia (low blood count), low vitamin D levels, and calcium in the urine.
What is the Treatment?
Luckily, most people recover from sarcoidosis without treatment. Often the inflammation and granulomas go away on their own. However, because we do not know exactly what causes sarcoidosis, if treatment is required, it includes medications that will suppress the inflammation and formation of nodules. Most likely, if the disease is severe enough to cause breathing problems, serious complications with other organs, or debilitating pain or weakness, your doctor will recommend starting treatment with glucocorticoids (steroids).
Steroids suppress your immune system, decreasing the inflammation causing the granulomas and the symptoms. Generally, high doses are started, and then they are tapered off in about 6 to 12 months. The reason for the tapering within a year is because taking steroids by mouth for a long period of time can have many negative side effects. However, it is also dangerous to suddenly stop taking steroids, so discuss any changes with your doctor first.
There are a number of other medications that your doctor may prescribe for sarcoidosis. Some will be for symptoms such as pain, and others will be used to try to suppress your immune response. It is important that you see a specialist with special knowledge of sarcoidosis to receive the treatment that is right for you.
Part of the treatment of sarcoidosis is monitoring the disease and looking for signs of new organ involvement. This means that you should expect routine chest X-rays and other radiologic tests. Your doctor will also monitor your blood and urine tests, as well as regular EKGs. Because of the serious possible consequences for your vision, it is very important that you have routine eye exams with your ophthalmologist.
If you have any more questions about sarcoidosis, are experiencing concerning symptoms, or have any other respiratory concerns, the caring staff at Lung and Sleep Specialists of North Texas are here to address all of your concerns. Please call us at (817) 549-9993 today. You can also request an appointment online.