A B C D E F G H I J K L M N O P R S T U V W

SARCOIDOSIS

What is Sarcoidosis ?

Sarcoidosis is a condition that can affect many organs of the body. It produces areas of 'inflammation' in affected areas. If pieces (biopsies) of these affected areas are examined under the microscope, the inflammation that is seen has a characteristic pattern. The three parts of the body most commonly affected are the lungs, the skin and the eyes. In the chest, lymph glands (which normally fight infection) enlarge at the root of each lung, and these can be seen on a chest x-ray. There may also be patches of inflammation in the lung tissues themselves. This sort of lung involvement may produce no symptoms at all, and the condition may be identified by chance on a routine chest x-ray. In other cases a dry cough may be persistent. With extensive involvement, breathlessness may develop. Vague chest pains may occur, sometimes with tiredness, weight loss or fever. Lymph glands may become enlarged in other parts of the body, particularly neck, armpits or groin. This happens in about one in four people with sarcoidosis. As with the chest, eye involvement may occur without symptoms, but 'grittiness', blurred vision and pain often develop. Detailed eye examination to detect the degree of involvement will usually be required. A characteristic skin reaction often occurs with the onset of sarcoidosis, and this is called erythema nodosum (EN). Large red rounded bumps appear, usually on the skin of the shins or forearms. They are usually quite painful, and tend to be associated with a painful inflammation of the ankles and knees. EN and the painful joints usually clear after 2 to 3 weeks, but recurrent crops can occur. No scarring is left once the nodules clear. EN is a peculiar condition, and can occur with other diseases, but sarcoidosis is the cause in more than half the cases. It may also affect the skin in other ways. Deposits of sarcoid tissue itself can occur in the skin as brownish purple lumps or flat patches. Previous scars may be involved, and become lumpy or discoloured. Less commonly, sarcoidosis may produce a mumps like swelling of the parotid gland in front of the ear. The nerve supplying the face muscles may be affected by this, causing a paralysed droop on one side. The disease is associated with increased blood calcium levels. This raised level of calcium in the blood (hypercalcaemia) can be serious, and may cause excessive thirst, constipation, nausea and vomiting.

How does Sarcoidosis occur ?

This is not known. No agent or factor that causes sarcoidosis has yet been identified. Animal experiments have suggested that a living organism or germ might cause infection with the condition, but no germ has been found in humans.

Why does Sarcoidosis occur ?

We don't know. It is not a very common disease (affecting about 1% of the population). It can develop at any age, but most commonly it is found between the ages of 20 and 40, slightly more often in women. There are reports of sarcoidosis running in families. It appears that a tendency towards developing sarcoidosis is inherited. The disease may then develop when these people are exposed to something in the environment, possibly infections.

Treatment involved for Sarcoidosis

You may require no treatment at all, and symptoms could subside within 1 to 3 months. The general symptoms of fever, tiredness and chest pains may require aspirin or other anti-inflammatory drugs (e.g. ibuprofen, naproxen). Careful checks on chest x-rays and breathing tests will usually be required. STEROIDS: More serious lung or eye involvement may require treatment with steroid (cortisone-like) drugs. This is a controversial area of treatment. Steroid tablets are usually needed in people with sarcoidosis affecting the heart or nervous system or with eye disease not responding to eye drops. It may also be needed for those with a high blood calcium. Steroid drops for the eye may be sufficient. If steroids are prescribed, they do need to be taken regularly as prescribed by the doctor. The dose may vary as the disease progresses and clears. It may need to be increased temporarily if an infection occurs, or an operation is required. IMMUNOSUPPRESSANT DRUGS: These act by damping down the body's stimulus to inflammation. They may be used in addition to or in place of steroids. Azathioprine or methotrexate are sometimes used. Anti-malarial drugs, such as chloroquine may also be used. People treated for sarcoidosis need to be checked regularly in order to find out if the treatment is working and to ensure it is not causing any side effects.

During treatment for Sarcoidosis

New effects of sarcoidosis can occur at any time while the disease is active. Most, however, occur near the onset of the illness. Any new symptoms, such as rashes or lumps should be reported rapidly to the doctor. Steroid drugs may cause indigestion, fluid swelling, weight gain, or a tendency to bruise easily. The dosage or timing of the drugs can be altered to minimize these side effects. Immunosuppressant drugs may alter the ability to fight infections (as may high doses of steroids). Any infections should be reported immediately to the doctor, as blood tests will need to be checked, and the dose of drugs altered. Antibiotics may be needed, plus a temporarily increased dose of steroids.

If Sarcoidosis is left untreated

You are likely to clear the disease fully within 2 years most likely without the need for treatment. If this happens, it is rare for sarcoidosis to recur. Serious eye, lung or nervous system involvement must be treated, or there is a chance that any damage will become permanent.

Effects on the family of Sarcoidosis

People with sarcoidosis are not infectious, so no segregation or special precautions are needed. Family and friends should understand that you may tire easily, get breathless, or feel generally below par whilst the disease is active.