Sarcoidosis is a condition that results in inflammation of various organs in the body. It is not a specific disorder that affects a particular organ. It is a well known fact that immune system is our defense parade that protects us against any foreign substance that enters into the body. During the fight between the immune cells and the foreign substances the body reacts by forming an inflammation. Once all the foreign substance is cleared the immune cells goes away. But in people who have sarcoidosis, the immune cell doesn’t go away and the inflammation remains. The gathered immune cells form lumps called as granulomas in various organs of the body. Sarcoidosis can form in any organ but it is most likely to occur in lungs, skin, and lymph nodes in the chest. Sarcoidosis can be mild or severe and sometime cause long lasting damage.
Causes
The exact cause of sarcoidosis is unknown but it is speculated that activation of immune system in response to bacteria, virus, dust or chemical may result in the disorder. Genetics also plays a role in sarcoidosis, where presence of certain gene increases the risk factor. Excessive sensitivity to environmental factors may also increase the risk of developing sarcoidosis. Sarcoidosis affects people from all ethnic groups and from all ages, but it is most likely to affect Caucasians of the Europe descent and African-Americans, it affects before 50 years of age, with high risk between the ages 20 to 40 years. Sarcoidosis is not contagious.
Symptoms
Sarcoidosis usually does not show any symptoms, if shows, the symptoms vary according to the organ affected. The most common symptoms of sarcoidosis involve lungs, skin, eyes, and liver. Lungs are the most commonly affected organ and the symptoms include breathing problem, cough, and chest pain. Rashes and nodules can occur in case of skin sarcoidosis. In case of liver sarcoidosis, the liver swells and very rarely it causes the liver cirrhosis. Enlargement of lymph nodes can occur, especially in the chest. Sarcoidosis in eyes can cause blurred vision, and rarely blindness. It may also cause eye dryness or swelling of the tear gland making the eyes water. Very rarely, it affects the nervous system causing muscle weakness, paralysis, seizures, tremors, difficulty walking, hearing loss, and poor coordination of the mind and body. Heart sarcoidosis causes abnormal heart beat and improper pumping of heart, a condition termed as congestive heart failure. Pain, swelling, and stiffness in the joints are caused if bones are affected. People with salivary gland granulomas can suffer from dry mouth.
Diagnosis
As sarcoidosis does not restrict itself to one particular organ, there is no specific diagnostic procedure for sarcoidosis. If sarcoidosis is suspected then the diagnosis starts with medical history about any previous case of sarcoidosis in the family, contacted or exposed to any triggering element that might have resulted in granulomas formation. Doctor may perform other tests to exactly know which organ is affected. Physical examination for sarcoidosis includes looking for symptoms like bumps on skin, enlarged liver, lymph node, spleen, and salivary gland or redness in the eyes. Doctor may also listen to heart and lung, any abnormal breathing or heartbeat signals that sarcoidosis may be affecting heart or lungs. As sarcoidosis very commonly affects lungs and lymph node, a chest X-ray can help to see the changes in the appearance of lungs, heart, and enlargement of lymph node. Lung function test is done to check the size of the lungs and how much and how fast the patient can breathe in and out. This test also determines how well the lungs deliver oxygen to other parts of the body. Biopsy of the organ that is suspected to be affected with granulomas confirms sarcoidosis. Taking biopsy sample is easy for organs like skin, lymph node, and tear gland that are located just below the skin but taking biopsy for internal organs might require Positron Emission Tomography (PET), which pinpoints the areas of biopsy. Slit-lamp test is used to examine the inside of eyes, even if there is no eye symptoms as eye damage do not cause any symptoms. Other tests include electrocardiogram (EKG), echocardiogram, computer tomography (CT), 24-hour urine calcium excretion etc.
Treatment
Treatment is not required for everyone with sarcoidosis as it goes away on its own. Whether treatment is required or not is determined by the doctor depending on the signs and symptoms, which organ is affected, and how severely it affects the functioning capability of the organ. Sarcoidosis of organs like eyes, heart, and brain requires treatment even if they do not show any signs and symptoms. A close wait and watch method will be followed if there is no worsening of the disease, but if the disease is worsening then doctor may prescribe few medicines like prednisone, which is a steroid drug, it is the main drug for sarcoidosis as it reduces inflammation. In many people, prednisone relieves symptoms within 2 months. In case, if the prednisone is worsening the symptoms or show some side-effects then other medicines prescribed are Hydrochloroquinone is prescribed if the patient is suffering from skin or brain sarcoidosis. For sarcoidosis of lungs, eyes, skin, and joint the patient will be prescribed methotrexate as it is an immunosuppressive drug that suppresses the immune system. Other immunosuppressive drug includes azathioprine and cyclophosphamide. Oxygen therapy will be a best option for people with severe sarcoidosis as it helps to minimize the complication of heart and lung that is caused due to lack of oxygen.
Oulook
Ongoing care is very essential for sarcoidosis even if the patient does not show any signs and symptoms and do not take any treatment. As suddenly symptoms can appear over night or the already existing symptoms may worsen. Schedule for visiting the clinic depends on how severe the symptoms are and what organ is affected.
