Sarcoidosis definition, explanation and treatment

Definition

Sarcoidosis is a systemic granulomatous disease characterized by small growths or lumps involving the entire body and causing inflammation or even swelling associated with the tissue of the affected area.[1]

lumps as seen on chest x-ray

Explanation

Over 90% of the confirmed cases, suffer of inflammation in the lung area, which is termed as pulmonary sarcoidosis.[8]

However, sarcoidosis also occurs in the lymphatic system, eyes, skin, big joints, spleen, liver, kidneys, cardiovascular system, the brain, salivary glands or even nerves.[1]

Facts about Sarcoidosis:

1. Sarcoidosis occurs more frequently in Caucasian white people of European ancestry and is well spread amongst African-Americans.
2. It is also typical in young people aged between 20 and 40
3. It affects females more than males.

Causes

Sarcoidosis is a genetic disease, but the cause have not been identified and the treatment course is often not clear.[1]

Signs and symptoms

The majority of patients with sarcoidosis are asymptomatic, though many suffer from a number of vague physical symptoms involving the whole organism and including weight loss, fever and malaise. Less commonly, some people experience local symptoms connected with a particular organ or system.[1]

More than half of the patients with sarcoidosis have no warning signs preceding the onset of the disease, therefore making the diagnosis is difficult.

Common Signs and Symptoms with organ involvement are listed below

A- Lung area

1. Lack of breath, the patient have a compromised ability to breathe fresh air, and he feels the inability to take a full breath
2. Wheezing, a loud whistling sound made while breathing, especially when exhaling (breathing out).
3. Hoarseness, abnormal voice changes, which can be caused by a variety of conditions. It can be determined using a stethoscope.
4. Dry cough with sputum, a persistent dry cough with sticky thick sputum, which is hardly evacuated from the bronchial tubes. In some chronic obstructive pulmonary diseases sputum is evacuated heavily, while in tuberculosis and asthma sputum is released more easily.
5. Chest pain, pleuritis (inflammation of the pleura) is a main concern of patients with sarcoidosis, it is associated with cough and the ongoing progressive lung inflammation.[1]
6. Rigidity in the chest, sarcoidosis can effect the joints connecting the ribs to sternum, thus limiting the elasticity of the chest, and the amount of air the lungs can take.
7. Lymphadenopathy and involvement of the lymphatic system, which is characterized by abnormal enlargement of the lymph nodes. The diseases starts with a local node involvement, following it will spread first to regional lymph nodes before it spreads to the other nodes throughout the lymphatic system in the terminal phase (generalized disease).

B- Eye and vision

1. Iridocyclitis, a painful ophthalmological disease caused by dryness or injury and characterized by chronic inflammation and irritation of the iris and the ciliary body of the eye. (Ocular sarcoidosis).[12]
2. Red eye or Conjunctivitis, is mainly caused by chronic irritation and dryness.
3. Ocular itching and burning, is usually a symptom of eye dryness, which is characterized by pain and itchiness, the condition in itself is caused by Lacrimal Duct Obstruction; Mucus builds up in the lacrimal ducts and decreases the cleansing capability of the eye by obstructing or altering the flow of liquids responsible for moisturizing and cleaning the exposed part of the eye.[9]
4. Blurred vision, is usually caused by thick mucus, inflammation, and irritation. These factors usually build together and can cause your vision to be blurred.[1][13]
5. Photophobia (fear of light)

C- Pores and skin

1. Small, pink or even purplish areas on the face, as clogged pores can induce inflammation.
2. Erythema nodosum a painful dermatological condition where red lumps commonly form on the hip and legs, this condition is usually combined with arthritis and aches in legs, ankles, hands and wrists.[1][12]
3. Lupus pernio a chronic purplish cutaneous lesion, which develops gradually on the nose, face and ears.
4. Painful nodules (lumps)

D- Bones and articular system

1. Joint and muscle discomfort (lost elasticity)
2. Sunken skin lesions on fingertips and feet.[11]
3. Enlarged Spleen and Liver (due to ongoing inflammation)

E- The Heart

Abnormal heartbeats, arrhythmia’s are common in patients with sarcoidosis.

F-Nervous System

1. Numbness or Loss of feeling
2. Loss of muscle power (Loss of muscular control by damage to the portion of the brain or spinal cord that controls voluntary movement, which usually blocks or delays the signal sent from the central nervous system to the muscles).[1][10][11]
3. Headache it is usually caused by hypoxia, as headaches occur within 24 hours of hypoxia with PaO2 less than 70 mmHg.[2]
4. Dizziness
5. Seizure
6. Meningitis

 

Analysis

For the proper diagnosis of Sarcoidosis, a physical examination and various lab tests or diagnostic methods are conducted.

During the physical examination, the physician may discover swollen painful lymph nodes and dry cough.

If a change in your vision is detected, the physician will forward you to see an ophthalmologist (eye specialist). The ophthalmologist will use a slit lamp to detect eye inflammation.

Lab tests may include

1. Upper body x-ray (Upper Body Imaging).
2. Chest x-ray (Imaging of the lung area, heart, and local lymph nodes).[8]

The physician will certainly look for enlarged lymph nodes and small circular spots in the chest known as granulomas.

Pulmonary function tests (PFTs) a group of tests that measure the functionality of the lungs to determine whether or not the patient has a lung problem. These procedures can detect airflow obstruction(s), which often decrease the oxygenation and diffusing capacity of the lungs “airflow limitation”. [3]

Blood tests

Blood tests are conducted to evaluate the quantity and shape of blood cells, and to show how well bone marrow stem cells are working. Blood tests are also used to measure the amount of blood proteins and calcium to identify liver malfunction.

Biopsy, by taking a small sample tissue of your skin, lymph nodes, or salivary particles to help make the diagnosis.

Treatment of Sarcoidosis

People with acute sarcoidosis only need painkillers to relieve the pain of arthralgias, myalgias and skin lesions.[1]

The treatment for generalized inflammatory myopathy includes physiotherapy and anti inflammatory drugs to decrease the inflammation.

Non-steroidal anti-inflammatory drugs (NSAIDs) are used to treat arthralgias and myalgias, Traditional NSAIDs include diclofenac (Cataflam pills, vortaren pills and cream and zipsor), panadol and ibuprofen.[1][6][7]

For patients with severe generalized sarcoidosis, corticosteroid medications are indispensable. These drugs improve lung function, decrease pulmonary granuloma formation and prevent lung damage.

Prednisone, a traditional Corticosteroid used to treat painful periods, and inflammation.

To relieve pores and skin lesions, a topical lotion is recommended. (Triderma)

Corticosteroid sprays are used to treat eye problems (Topical prednisone for the eyes).

Sarcoidosis mandates a long term course of corticosteroids, patients need to take steroid tablets on a long-term basis, and in case of drug shortage the active disease may recur.[5]

Routine Examination and checkups are required to monitor the sickness and to control the potential side effects of long term corticosteroids.

Side effects of long term corticosteriod utilization include:

1. Mood swings
2. Inflammation
3. Weight gain
4. Increased blood sugar level
5. High blood pressure.

Corticosteroids must be used carefully and in low dosages, the benefits of optimal corticosteroid therapy outscore the possible side effects.[3][1]

Numerous novel drugs undergone trials to be used along corticosteroids; However, their effectiveness has not been established yet.

 

 

References

1. medcoi.science [systemic granulomatous disease]
2. ihs-classification.org/en/02_klassifikation/03_teil2/10.01.00_homoeostasis.html
3. morgansci.com/pulmonary-function-solutions/what-is-a-test-pulmonary-function-test/
4. nhs.uk/Conditions/Corticosteroid-(drugs)/Pages/sideeffects.aspx
5. ncbi.nlm.nih.gov/pubmed/16946094
6. nhlbi.nih.gov/health/health-topics/topics/sarc/treatment
7. my.clevelandclinic.org/health/diseases_conditions/hic_Overview_of_Sarcoidosis/hic_Sarcoidosis_Treatment_Options
8. static.medicine.iupui.edu/divisions/rheu/content/patienthandouts/Sarcoidosis_brochure.pdf
9. nhlbi.nih.gov/health/health-topics/topics/sarc/signs
10. en.wikipedia.org/wiki/Neurosarcoidosis
11. ildcare.eu/Downloads/artseninfo/Sarcoidosis/Chapter 13 Sarcoidosis joint muscle and bone.pdf
12. my.clevelandclinic.org/ccf/media/Files/Respiratory/sarcoidosis-center/2012-sarcoidosis-patient-conference/ocular-sarcoidosis.pdf?la=en
13. nlm.nih.gov/medlineplus/ency/article/000720.htm

 

 

 

 

 

Verified by: Dr.Diab (September 6, 2020)

Citation: Dr.Diab. (September 6, 2020). Sarcoidosis Facts Symptoms and Treatment. Medcoi Journal of Medicine, 22(2). urn:medcoi:article1196.