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Sarcoidosis: Causes, symptoms, and treatment

Date: Jun-27-2017
Sarcoidosis is a condition involving the growth of persistent or inappropriate granulomas or clumps of inflammatory cells. But what causes them and how can they be treated?

While sarcoidosis can occur in any organ, an estimated 90 percent of cases involve the lungs.

Currently, there is no cure for sarcoidosis, although some cases resolve without medical intervention.

Granulomas can damage organs and may require treatment. This may be the case if they begin to take up a significant portion of an organ or persist for a long time.

This article looks at the causes and symptoms of sarcoidosis and explores how they may be treated.

Contents of this article:

What is sarcoidosis?

Risk factors

Symptoms

Diagnosis

Treatment and outlook

What is sarcoidosis?

While sarcoidosis can occur in any organ, it occurs most commonly in the lungs.

Sarcoidosis is a chronic inflammatory condition that leads to the formation of persistent granulomas or clumps of inflammatory cells.

Granulomas are formed as a normal part of the immune response, but they typically break up after foreign objects or irritants have been expelled.

Sarcoidosis involves the development of granulomas that form or linger when they are no longer needed.

Researchers are still not sure why or how sarcoidosis occurs. However, it may be the result of an excessive immune response to an irritant or allergens, such as:

viruses

bacteria

pollution

dust

chemicals

There is some evidence to suggest certain individuals may be more genetically predisposed to develop the condition.

The bulk of sarcoidosis cases involve or begin in the lungs. The lymph nodes and glands, especially those surrounding the lungs, are also impacted. However, sarcoidosis can affect any organ in the body.

Though less common, cases involving organs, such as the heart, brain, and kidneys, are often far more severe. Also, they can be difficult to treat and may cause serious health complications.

Risk factors

An estimated 10-15 in 100,000 Americans develop sarcoidosis annually.

However, the actual risk of developing the condition varies, largely depending on individual factors. These include:

Race and/or ethnicity: Rates of sarcoidosis among African-Americans are estimated to be three to four times higher than white people.

Age: Sarcoidosis most commonly impacts those between 20 and 40 years of age.

Sex: As with most inflammatory conditions, women are considered at greater risk of developing sarcoidosis, especially over the age of 50.

Family history: Those who have family members who have had sarcoidosis are at a greater risk of developing the condition.

Further research is needed to better understand the association between race and ethnicity and sarcoidosis.

Symptoms

The symptoms associated with sarcoidosis can differ drastically between individuals.

Symptoms also vary greatly depending on the location of granulomas and the size of the organ involved.

In acute sarcoidosis, symptoms are present for less than 2 years, and half of those affected by them will have no symptoms after that.

In chronic cases, symptoms progress, linger or recur for weeks or years. The concern with chronic sarcoidosis is the progression from the granulomas to fibrosis in organs, such as in the lungs.

Noticeable symptoms only occur when granulomas have become invasive, accounting for a sizeable portion of the organ they are in. The development of symptoms also means that granulomas begin to impede or lessen the functioning of the organ.

Some of the signs and symptoms of sarcoidosis include:

fever

exhaustion

pain in the joints

weight loss

depression

cough

shortness of breath

wheezing

abnormal heartbeat

abnormal sweating

Rashes can also develop on the lower extremities, such as ankles and shins, or on the upper body.

More specific signs may indicate which organ is involved. Symptoms associated with sarcoidosis in specific organs are detailed below.

Lungs

Symptoms of sarcoidosis in the lungs include:

chronic dry cough

wheezing

shallow breath or dyspnea - a shortness of breath or trouble catching the breath

unidentifiable chest pain, often radiating out

Lymph nodes

Symptoms include a sore throat and swollen lymph nodes.

Symptoms of sarcoidosis in the lymphatic system include:

swelling or edema, excess buildup of fluid

pain

redness

difficulty swallowing

sore throat

general exhaustion or discomfort

Heart

Symptoms of sarcoidosis in the heart include:

pain, often radiating throughout the chest

feeling faint or fainting

unexplained exhaustion

palpitations with rapid, fluttering heart beat

arrhythmias or irregular heartbeat

edema or swelling caused by the build up of fluid

dyspnea or shortness of breath and/or difficulty catching breath

Eyes

Cases of sarcoidosis that impact the eyes do not often cause symptoms. This means many go undiagnosed until permanent damage has been done.

When present, the symptoms of sarcoidosis of the eye include:

pain or soreness

redness

sensitivity to light

blurred or cloudy vision

Nervous System

Symptoms of sarcoidosis of the nervous system include:

facial paralysis or loss of muscle control

inflammation in the brain, leading to seizures and other changes

meningitis symptoms, such as headache and neck stiffness

damage to small nerves

Skin

Symptoms of sarcoidosis of the skin include:

erythema nodosum, which is a raised red rash on the shins and ankles, often warm and tender to touch

nodules or growths under the skin, especially around scar tissue

skin discoloration, where some regions become lighter or darker than normal

lesions or sores, leading to permanent skin damage and disfigurement, often on the cheeks, nose, and ears

Joints, connective tissues, bones, and muscles

Sarcoidosis can cause arthritis and loss of flexibility.

Symptoms include:

arthritis

loss of muscle control, tone, or function

loss of flexibility, ease, or range of motion

generalized joint pain

generalized weakness and exhaustion

Diagnosis

Recognizing the signs of sarcoidosis can be difficult.

Some 90 percent of all cases are not significant enough for doctors to be able to diagnose them. They may also be undetectable by radiographic devices.

Diagnoses are often made during examinations or testing for other health conditions, for example, chest X-rays for:

pneumonia

injury

lung cancer

If sarcoidosis is suspected, a doctor will begin by examining the impacted area and reviewing a person's medical history.

Additional tests used to diagnose sarcoidosis include:

computerized tomography (CT) scan

positron emission tomography (PET) scan

chest X-ray to assess lymph node involvement and lung damage

lung function tests to assess lung volume or blood flow and associated oxygen delivery

examinations of the eyes

blood tests to assess organ function or change, in particular, measuring kidney enzymes and markers

biopsies of organ tissues

Treatment and outlook

Anti-inflammatory medications can help reduce the symptoms of sarcoidosis.

In approximately half of all sarcoidosis cases, symptoms resolve or go away on their own.

More severe or persistent symptoms benefit from medical treatment. Though there is currently no cure for sarcoidosis, therapeutic options exist to treat the symptoms.

Some of the medications and therapeutic options available include:

anti-inflammatory, topical or oral corticosteriods

immunosuppressants

surgery

hydroxychloroquine (Plaquenil)

tumor necrosis factor-alpha (TNF-alpha)

Complications

It is important that sarcoidosis is treated correctly as complications associated with long-term cases can include:

heart conditions

blindness

breathing difficulties

kidney damage or failure

muscle paralysis

skin disfiguration and discoloration

Written by Jennifer Huizen

Courtesy: Medical News Today
Note: Any medical information available in this news section is not intended as a substitute for informed medical advice and you should not take any action before consulting with a health care professional.