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Sarcoidosis

Pronounced: sar-coy-doe-sis

Definition

Sarcoidosis is a disease that causes inflammation in organs throughout the body. It forms small round spots, called granulomas, in various organs or tissue. The most common locations are the lungs and lymph nodes. The spots can make it difficult for the organs to work normally.

Causes    TOP

Inflammation is a normal part of how the body acts toward an infection or injury. However, the inflammation should pass once the area has healed. With sarcoidosis the inflammation does not pass. The cells that cause the inflammation stay and cause granulomas. It is not clear why this happens. An infection or exposure to a toxin in the environment may trigger the change.

Risk Factors    TOP

Sarcoidosis is more common in females and at ages 20 to 40 years old. Factors that may increase the chance of sarcoidosis include:

  • Ethnic descent—African-American, Northern European, Scandinavian, and Irish
  • History of sarcoidosis in:
    • Parents and siblings
    • Uncle, aunt, nephew, niece, grandparent, grandchild, and half-sibling
  • Exposures to dusty or moldy environment or certain occupations

Symptoms    TOP

There are few symptoms in early stages. Symptoms will depend on what organs are affected. Symptoms may come and go.

Many will feel flu-like symptoms such as:

  • Fever
  • Swollen lymph nodes

Lungs are often affected and can cause:

  • Cough
  • Shortness of breath
  • Wheezing
  • Chest pain
  • Fatigue, especially with exertion
  • Night sweats

Other possible symptoms may include:

  • Rash with swelling—erythema nodosum
  • Pain or irritation of eyes
  • Muscle weakness
  • Loss of appetite
  • Weight loss
  • Seizures
  • Tremors
  • Difficulty hearing
  • Blurred vision or blindness—if the eye is affected
  • Poor coordination
  • Trouble walking
  • Irregular heart rate
  • Pain, swelling, and stiffness in the joints
  • Facial paralysis known as Bell's palsy

Bell's Palsy

Facial droop and nerves
Copyright © Nucleus Medical Media, Inc.

Diagnosis    TOP

The doctor will ask about your symptoms and medical history. A physical exam will be done including listening to the heart and lungs and checking lymph nodes. Tests that may help find sarcoidosis signs or rule out other causes include:

  • Chest x-rays—can show sarcoidosis spots in the lungs or swollen lymph nodes
  • Biopsy—to look for granulomas or signs of other conditions such as infections

There is no specific test that confirms sarcoidosis. Instead, diagnosis is based on:

  • Combination of typical symptoms and results of imaging tests (mainly x-ray)
  • Biopsy that shows granulomas - may be from any organ
  • Eliminating other causes of illness

Other tests may be done to see how well the affected organs are working. Tests may be done even if there are no symptoms and may include:

Treatment    TOP

Not all sarcoidosis needs to be treated. Many will only have minor symptoms and the sarcoidosis will pass on its own. The doctor will monitor for any changes including regular eye exams and lung tests.

Treatment may be needed to ease more serious symptoms. It can also help to decrease the chance of permanent problems. Treatment may include:

Medical Care

Medication may help to manage the inflammation and decrease damage. Options include:

  • Steroids to decrease inflammation
  • Topical steroids to treat rashes
  • Methotrexate, azathioprine, or anti-tumor necrosis factor biologics for those who do not respond to steroids
  • Nonsteroidal anti-inflammatory drugs (NSAIDs) to treat musculoskeletal symptoms
  • Eye drops to treat mild eye problems
  • Antimicrobial drugs (antimalarial drugs or tetracyclines) to treat mild skin involvement

Pulmonary rehabilitation may help to improve lung function.

Surgery

If function does not improve or other treatments have failed, organ transplants may be needed. This may include the heart, lung, liver, or kidneys.

Prevention    TOP

There are no current guidelines to prevent sarcoidosis because the cause is unknown.

RESOURCES:

American Lung Association
http://www.lung.org
Arthritis Foundation
http://www.arthritis.org

CANADIAN RESOURCES:

The Arthritis Society
http://www.arthritis.ca
The Lung Association
http://www.lung.ca

References:

Explore sarcoidosis. National Heart, Lung, and Blood Institute website. Available at:
...(Click grey area to select URL)
Updated June 14, 2013. Accessed May 13, 2016.
Sarcoidosis. American Lung Association website. Available at:
...(Click grey area to select URL)
Accessed May 13, 2016.
Sarcoidosis in adults. EBSCO DynaMed Plus website. Available at: http://www.dynamed.... Updated August 10, 2017. Accessed 10/5/2017.
Sarcoidosis in children. EBSCO DynaMed Plus website. Available at: http://www.dynamed.... Updated January 28, 2011. Accessed May 13, 2016.
6/14/2016 DynaMed's Systematic Literature Surveillance http://www.dynamed...: Soto-Gomez N, Peters JI, Nambiar AM. Diagnosis and management of sarcoidosis. Am Fam Physician. 2016;93(10:840-848.
Last reviewed November 2017 by Michael Woods, MD
Last Updated: 11/20/2017

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