Sarcoidosis

Sarcoidosis: Overview

Sarcoidosis is a rare multi-system auto immune disease that is known for its long remissions and wide variety of symptoms.  Sarcoidosis symptoms vary from person to person; no two are exactly alike.  It is a granulomatous disease in which inflammation may occur in lymph nodes, lungs, liver, eyes, skin, joints, kidneys, liver and spleen, and other tissues.

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Incidence; Causes and Development

Sarcoidosis occurs in highly variable groups.  The disorder is slightly more common in people 25 to 50 years old, particularly women, but can occur at any age and to either sex.

The cause of Sarcoidosis is unknown, but some areas of exploration on its causes are:

  • A viral or bacterial infection (Sarcoidosis is not contagious, but resembles tuberculosis)
  • A defect in the body's immune system
  • An unidentified toxic substance
  • An unknown environmental cause
  • An inherited or genetic cause.

Signs and Symptoms

Over 90% of cases involve the lungs and may also involve any other area of the body.  Some cases will involve some portion of the nervous system.  The disorder involves an abnormal immune system response resulting in deposits of white blood cells and abnormal tissue cells in the affected organs.

The symptoms of sarcoidosis can vary greatly, depending on which organs are involved.  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.  Some symptoms, such as enlarged lymph glands in the chest and around the lungs, are not obvious.

Any part of the nervous system may become involved.  Involvement may be a single nerve, multiple nerves, or generalized.

There may be pain in the hands, feet or other bony areas due to the formation of cysts (an abnormal sac-like growth) in bones.

Diagnosis and Tests

Types of testing for sarcoidosis include: CBC; chem-7 or chem-20; ACE levels; chest X-ray; lymph node biopsy; skin lesion biopsy; bronchoscopy; open lung biopsy; gallium scan; nerve biopsy.

Treatment and Prevention

There is no known cure for this disorder, but more and more treatments are being tested.  Treatment mainly consists of reducing and relieving symptoms, bearing in mind that some cases resolve themselves in time and never experience further symptoms.  Many new medications and experiments are being conducted on sarcoidosis patients every day, and what works for one may not necessarily always work for another; it is important to discuss all your options with your physician.

Prognosis

Some patients (60%) have Sarcoid for a period of 2-3 years and never have it again, but others have it chronically, some with periods of remission.

Signs, symptoms & indicators of Sarcoidosis:

Symptoms - Cardiovascular

Arrhythmia

Symptoms of sarcoidosis can include development of abnormal or missed beats, inflammation of the covering of the heart (pericarditis) or even heart failure.

Symptoms - Food - Beverages

Symptoms - Glandular

(Frequent/multiple) swollen cervical nodes

Enlarged and tender lymph glands in the neck, armpits and groin are a possible sign of sarcoidosis.

Symptoms - Head - Eyes/Ocular

(Very) watery eyes

Red and teary eyes or blurred vision are common symptoms.

Symptoms - Head - Mouth/Oral

Symptoms - Head - Nose

Much reduced sense of smell

[Kieff, D; Boey, H; Schaefer, P; Goodman, M; Joseph, M (1997).  "Isolated neurosarcoidosis presenting as anosmia and visual changes".  Otolaryngology – Head and Neck Surgery 117 (6): pp183-6]

Nasal congestion

Nasal symptoms and signs occur in 1-6% of sarcoidosis patients [McCaffrey TV, Donald TJ.  Sarcoidosis of the nose and paranasal sinuses.  Laryngoscope 1983;93: pp.1281-4], including crusting, nosebleeds (epistaxis) and bilateral obstruction.  Distinctive tiny yellow submucosal nodules can sometimes be seen.

Symptoms - Metabolic

Symptoms - Mind - General

Symptoms - Respiratory

Symptoms - Skeletal

(Minor/major) joint pain/swelling/stiffness

Chronic arthritis (swollen and painful joints) could indicate sarcoidosis.

Symptoms - Skin - Conditions

Occasional/frequent/regular rashes

Skin lesions and rashes – tender reddish bumps or patches on the skin – are common.

Conditions that suggest Sarcoidosis:

Aging

Hearing Loss

Nervous system effects, including hearing loss, meningitis, seizures or psychiatric disorders (for example, dementia, depression, psychosis) are possible signs of sarcoidosis.

Circulation

Dental

General

Infections

Mental

Metabolic

Nervous System

Organ Health

Kidney Stones (Urolithiasis)

Kidney stone formation can be a sign.

Symptoms - Respiratory

Recurrent/acute bronchitis

Most patients initially complain of a persistent dry cough, fatigue, and shortness of breath.

Uro-Genital

Risk factors for Sarcoidosis:

Symptoms - Head - Eyes/Ocular

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Sarcoidosis suggests the following may be present:

Autoimmune

Sarcoidosis could instead be:

Hormones

Nervous System

Neuritis/Neuropathy

It is often difficult to diagnose Sarcoidosis as signs may mimic diabetes, hypopituitarism, optic neuritis, meningitis, tumors, or other neurologic disorders.

Organ Health

Diabetes Type II

It is often difficult to diagnose Sarcoidosis as signs may mimic diabetes, hypopituitarism, optic neuritis, meningitis, tumors, or other neurologic disorders.

Recommendations for Sarcoidosis:

Drug

Conventional Drug Use

Corticosteroids such as prednisone and/or other anti-inflammatory medications can be prescribed to reduce inflammation.  Other medications, particularly those that suppress the immune system, are often recommended.  Lung involvement may benefit from inhalers; each symptom can usually be relieved by treating with appropriate medications.

Hormone

Melatonin

At least two cases of sarcoidosis have been successfully treated with 20mg of melatonin per day.  These were chronic sarcoidosis cases unresponsive to long-term steroidal therapy.  [The Lancet November 4, Vol 346, pp.1229-30, 1995]

Physical Medicine

Physical Supports and Devices

Weak areas due to arthritis may require physical therapy and/or appliances to aid mobility and ability to function.

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