Sarcoidosis - An Insight

Introduction

Sarcoidosis is granulomas (abnormal masses) formed due to inflammation in various organs like lungs and lymph nodes. It alters their structure and function. It is associated with high serum calcium levels. Sarcoidosis affects individuals between the age of 20 and 40 years. The female gender is diagnosed with sarcoidosis more than men. Pulmonary (lung) sarcoidosis is a severe disease resulting in fibrosis. The sarcoidosis starts slowly and progresses rapidly.

What Are the Various Causes of Sarcoidosis?

There is no specific cause for sarcoidosis.

• Autoimmune Disorder - The abnormal activity of the immune system favors the inflammatory mechanism and produces sarcoidosis.

• Weakened Immunity - HIV (human immunodeficiency virus) infection causes a low immune response in the body, which also elicits sarcoidosis.

• Lofgren's Syndrome - It usually manifests in the form of fever and adenoids. This syndrome resolves in six months to one year after treatment.

• Genetic Cause - Sarcoidosis has a high risk of familial inheritance. Research is required to determine the exact gene responsible for sarcoidosis.

What Are the Different Symptoms Associated With Sarcoidosis?

The initial symptoms of sarcoidosis are as follows:

• Fever - The patient with sarcoidosis gets a fever and joint pain due to the abnormal inflammatory response. It also causes swelling of the joints.

• Breathing Problems - The sarcoidosis with lung fibrosis causes shortness of breath.

• Cough - The persistent cough due to lung involvement makes the patient exhausted.

• Weight Loss - The inflammation of major organs results in weight loss.

The symptoms associated with organs are as follows;

• Lymph Nodes - The lymph nodes affected by sarcoidosis appear enlarged. The commonly involved lymph nodes are present in the neck, armpits, lungs, chest, and groin and are tender to touch.

• Kidneys - The kidneys fail to eliminate the lumps of inflammatory cells. This eventually leads to the formation of kidney stones and causes pain near the abdomen.

• Liver - The sarcoidosis results in enlargement of the liver, due to which there is a sharp, stabbing pain with discomfort in the stomach.

• Nervous System - If the sarcoidosis affects the nerve, it causes neurosarcoid. And results in seizures or epilepsy.

• Heart - Cardiac sarcoidosis causes arrhythmias (irregular heartbeats) along with inflammation (pericarditis). Excess inflammation leads to heart failure.

• Sensory Organs - The skin appears red due to sarcoidosis. It forms patches and causes itching. The eyes produce excess tears and appear red. Severe sarcoidosis leads to blurred vision. If the disease involves the voice box, it causes hoarseness.

• Bone - The accumulation of abnormal cells forms cysts in the bone. It is commonly found in the hands and feet. It gradually increases in size and induces pain.

What Are the Diagnostic Procedures Used to Diagnose Sarcoidosis?

Since sarcoidosis has symptoms similar to other diseases, one diagnostic test cannot be used to confirm. So the laboratory results are carefully examined by the pulmonologists. They are as follows;

• Chest X-Rays - The enlarged lymph nodes and inflamed lungs can be diagnosed using chest X-rays. The lung affected by sarcoidosis shows a specific pattern in the radiographic image. But the stages cannot be diagnosed using chest X-rays. Pulmonary (lung) infiltrations due to sarcoidosis can be observed. The expansion of lung tissue can also be determined.

• CT (Computerized Tomography) Scan - It provides elaborated information about the lymph nodes and lungs compared to the chest X-rays. It gives results in ten minutes. The sarcoidosis progresses into or throughout the pleural (lung) tissue and is identified using computerized tomography. The retraction at the corner of the lungs and scarring can also be observed.

• Bronchoscopy - The tube passes through the bronchial tube and helps in inspecting the enlarged tissue. In order to determine the type of infection, the granulomas are collected with a special tool. It is useful in making an accurate diagnosis of sarcoidosis. In order to obtain a lymph node sample, the needle is inserted into the bronchoscope. It is then collected for biopsy.

• Blood Test - The protein level in the blood is determined to diagnose sarcoidosis. The serum calcium level is tracked to check the abnormality in the kidneys. The presence of excess levels of angiotensin-converting enzymes and interleukins indicates granuloma formation. This is possible in sarcoidosis as well as other diseases. So other additional procedures are required along with blood tests for diagnosing sarcoidosis.

• PET (Positron Emission Tomography) Scan - The fluorodeoxyglucose is injected into the vein to diagnose sarcoidosis. This dye collects and indicates the areas with granulation tissue. The location and inflammation can be detected using the scan.

What Are the Treatment Methods for Treating Sarcoidosis?

The treatment of sarcoidosis depends on the extent of the organ involved.

1. Medications - Sarcoidosis is treated with potent anti-inflammatory drugs. Steroid creams are used for lesions on the skin, and drops are used for the eyes. Methotrexate is used to reduce the abnormal immune response. Hydroxychloroquine is used to manage patients with high serum calcium and skin lesions. The joint pain and inflammation are treated by tumor necrosis factor-alpha inhibitor.

2. Surgery - The patient undergoes rehabilitation to improve the symptoms of pulmonary sarcoidosis. However, the lung affected due to sarcoidosis and fibrosis is removed, and a new organ is transplanted. The conditions related to the heart are managed by placing a pacemaker to regulate the heartbeat.

Conclusion

The course of the disease varies in each patient. Some have generalized symptoms, while others are affected only in the lungs. Consult a pulmonologist if found to be likely to have symptoms of sarcoidosis. Few patients with sarcoidosis remain asymptomatic for years, even if the organs are involved. Many patients recover after three to four years. The symptoms of sarcoidosis recur even after treatment over a long period. So, there is no complete cure for sarcoidosis, but the disease subsides with treatment in due course. Research says one in 10,000 people in the United States is affected by sarcoidosis. It commonly occurs in Africans and Americans. These patients should avoid calcium-rich foods. Avoid direct sunlight, and do not sunbathe. Physical therapy helps in reducing fatigue, and the symptoms must be carefully monitored to determine the treatment efficacy. Patients with sarcoidosis require a life-long follow-up. They should strengthen their muscle through a healthy lifestyle and physical activities. Seek help from the counselor for coping troubles due to sarcoidosis.