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Sarcoidosis - Stages, Symptom, Treatment And Causes

Last Updated: Nov 07, 2019

What is Saracoidosis?

Sarcoidosis is an inflammatory disease, whereby clumps of inflammatory cells or granulomas, form in various organs. This disease is often triggered by the patient’s body’s immune system, when it responds to foreign bodies like chemicals, bacteria and viruses.

What are the different types of sarcoidosis?

Different types of sarcoidosis:

  1. Pulmonary sarcoidosis: It refers to sarcoidosis affecting the lungs and it is a quite common type. Granulomas can affect the normal function of the lung. It may lead to cough, shortness of breath, chest pains, wheezing, etc. If the condition is untreated, bronchiectasis will appear.
  2. Ocular sarcoidosis: Ocular sarcoidosis alludes to sarcoidosis influencing the eyes or the encompassing structures too. This condition may appear in around 50 percent of sarcoidosis patients and the manifestations can fluctuate contingent upon which parts of the eye are influenced, with the most widely recognized inconvenience being uveitis. Uveitis incorporates redness, inflammation, and torment in the eyes, and can cause vision variations from the norm, for example, floaters. Whenever left untreated, visual sarcoidosis can prompt difficulties, like, glaucoma and waterfalls. It can cause vision misfortune.
  3. Neurosarcoidosis: It mostly affects regions of the brain which produce hormones such as, pituitary, and the hypothalamus. It can disturb systems such as menstrual cycles in female patients. The peripheral nervous system will also be affected and the same will lead to problems in motor functions.
  4. Musculoskeletal sarcoidosis: It does not cause any symptoms; however, it affects the bone and causes inflammation. This condition is very rare. Chronic muscle weakness is experienced.
  5. Cutaneous sarcoidosis: Sarcoidosis can cause a few skin intricacies, happening in around 20-35 percent of patients.
  6. Hepatic sarcoidosis: In this condition, the liver is involved. Rarely, this condition affects the organ’s function. Cirrhosis or portal hypertension is caused in very rare cases.
  7. Renal sarcoidosis: Sarcoidosis can prompt kidney stone arrangement, kidney harm, or kidney infection. This can be because of sarcoidosis causing fluctuates the calcium digestion. This causes an excess of calcium in the blood (hypercalcemia). Irritation, caused by granulomas in the kidneys, can cause scarring and changeless kidney harm.
  8. Cardiac sarcoidosis: Heart is affected in this condition and only 5% of patients will experience the symptoms. Arrhythmia, irregular heartbeats are the symptoms as the granulomas interfere with the electrical signals that stimulate the heart muscle contraction.
  9. Spleen and bone marrow sarcoidosis: Sarcoidosis of the spleen and bone marrow can bring about cytopenia — or low platelet tallies. Bone marrow is engaged with the creation of platelets, so when sarcoidosis influences the bone marrow, this can prompt variations from the norm, for example, frailty, or low red platelets. The spleen is associated with sifting through platelets, and if it isn't working accurately, too much, or an inappropriate sort of platelets, can be expelled.

What are the stages of pulmonary sarcoidosis?

  • Stage 0 - NO SARCOIDOSIS: The patient presents with an ordinary x-ray and there is no indication of granulomas.
  • Stage I - LYMPHADENOPATHY: Granulomas can be seen in lymph hubs.
  • Stage II - LYMPHADENOPATHY AND PULMONARY INFILTRATES: Sarcoidosis can be seen in the lymph hubs and also in lung tissue.
  • Stage III - PULMONARY INFILTRATES: Granulomas are there in the lung tissue.
  • Stage IV - PULMONARY FIBROSIS: There is scarring in the tissues of the lungs, demonstrating irreversible harm.

The places which are mostly affected by sarcoidosis are:

  • Lungs
  • Lymph nodes
  • Eyes
  • Liver
  • Spleen
  • Skin
  • Heart and
  • Brain

Although the exact reason for developing this disease is still unknown, but it is assumed that gender, race and genetics can enhance the risk of getting affected with this disease. For it has been found that women are more at risk of developing this malady. People of African-American origin are also mostly affected by sarcoidosis. Apart from this, people with family history of sarcoidosis have a significant higher ris of getting this disease.


What are the early symptoms of sarcoidosis?

Sarcoidosis is an inflammatory disease in which multiple organs are affected in the body. However, the lungs and lymph glands are mostly affected by this condition. Abnormal nodules or masses contain inflamed tissue (granulomas) form in certain organs of the body in people with sarcoidosis. These nodules would alter the normal structure and the function of the affected organs. Depends on the affected organs, the symptoms of sarcoidosis vary. Mostly, a persistent dry cough, shortness of breath, and fatigue are noted in common. Other symptoms are :

  • Blurred vision, red and teary eyes
  • Swollen and painful joints
  • Hoarse voice
  • Tender and enlarged lymph glands in the armpits, groin, and neck
  • Reddish patches or bumps on the skin.
  • Enlarged liver
  • Formation of kidney stone
  • Missed heartbeats, heart failure, and pericarditis
  • Depression, dementia, loss of hearing, seizures

How to diagnose sarcoidosis?

There is no special test for diagnosing sarcoidosis as other diseases mimic the same symptoms.

  • Chest X-ray: The patient will be initially advised to go for a chest x-ray which will provide a clear picture of the heart, lungs and surrounding swollen lymph nodes. It will reveal the place of infection-fighting white cells that is the first sign of sarcoidosis.
  • Bronchoalveolar lavage: Bronchoscopy test helps in inspecting the bronchial tubes and to take out the tissue for biopsy. In a biopsy, the granulomas will be checked out to rule out the infection.
  • Mediastinoscopy is an invasive procedure to diagnose sarcoidosis but now EBUS-guided biopsies are turned popular.
  • Gallium scanning: Gallium scanning procedure involves injecting gallium-67 into a vein. The scan indicates which tissues and amount of tissues affected. Any type of infection occurring in the body will be revealed in this scan.
  • Biopsy: Purified protein derivative is a type of skin test that is used to find any prior exposure or infection with Tuberculosis. As many times TB is confused with sarcoidosis, this test is performed often. The skin test will be negative / non-reactive in the case of sarcoidosis.
  • Lung Function Test: Often LFT (Lung Function Test) is recommended to the patients for determining whether this disease has affected the patient’s lung capacity.
  • Blood test: Blood tests are also done for the patients to check the condition of the kidney and the liver.

What is the life expectancy of a person with sarcoidosis?

Mortality rate in sarcoidosis:

The normal clinical course among these 22 patients was 10 years from the beginning of the sickness. The normal age at death was 39 years. Patients who kicked the bucket of focal sensory system and cardiovascular sarcoidosis were more youthful, and their clinical course was shorter. Subclinical sarcoidosis doesn't appear to influence life length.

What is the best treatment for sarcoidosis?

The patients are initially administered in corticosteroids. These drugs have the tendency of reducing the body’s inflammation. It gives better relief in patients within a few months of time. Prednisolone and prednisone are the most commonly prescribed corticosteroids. As the drugs have side effects such as weight gain, acne, insomnia, elevated blood sugar, bone loss and cataracts, the physician will gradually taper the dose after your start of the steroids.

Anti-malarial drugs are normally used for malaria treatment. People who have severe skin symptoms or a high level of calcium in their bloodstream will be treated with medicine. Chloroquine and Hydroxychloroquine are the most common antimalarial drugs that are also given for sarcoidosis. Both the drugs might cause eye issues and stomach upset.

As sarcoidosis is an auto-immune disease, using immune-suppressing medicines will alleviate the symptoms and prevent the organs from further damage. When corticosteroids are not effective, the doctor may recommend immune suppressants such as azathioprine, mycophenolate mofetil or methotrexate.

If needed doctors does prescribe anti-inflammatory medications for sarcoidosis patients. These medicines generally consists of anti-rejection medications and corticosteroid medicines that helps to reduce the inflammations.

What are the side effects of sarcoidosis?

Sometimes, the condition sarcoidosis leads to many complications in the systems.

  • Eyes: Inflammation persisting from the condition can affect any part of the eye and simultaneously may cause damage to the retina. It can ultimately cause loss of sight. Hardly, sarcoidosis may also cause cataracts and glaucoma.
  • Heart: When the heart is affected, granulomas may be developed and that can disturb heart rhythm, heart function, and even blood flow. In rare cases, death occurs.
  • Neuro system: When granulomas form in the spinal cord or in the brain, the victims develop problems connected to CNS. The main issue is facial paralysis due to inflammation in the facial nerve.
  • Lungs: Pulmonary fibrosis, i.e. permanent scarring would be caused by untreated lung sarcoidosis. It might lead to breathing difficulty and pulmonary hypertension.

What are the complications of sarcoidosis?

There is no cure for this disease as of date. However, it has also been noticed that at times symptoms of sarcoidosis often improves even without any treatment. Although most people diagnosed with sarcoidosis do not experience any major complications, however, if this illness persists for a long time and becomes a chronic condition it can develop complications. It has been seen that patients affected with chronic sarcoidosis later on in their life develop lung infections, have abnormal heart beat, find difficulty in conceiving, have kidney failure or have facial paralysis. Eye diseases like cataracts and glaucoma are also common with sarcoidosis patients.

How to prevent sarcoidosis?

Despite many years of research, the root cause of sarcoidosis has been a mystery. It has been believed that various reasons contribute to trigger the damage of the immune system response and ultimately lead to granulomas. The bacteria or viruses are the suspected aspects, but until now none of them has been identified as a strong cause. Hence, there is no way to prevent sarcoidosis. If you are prone to high risk of the disease, stay away from the environmental substances such as mold, insecticides or other items that would trigger it.

What foods should be avoided with sarcoidosis?

1. The sarcoidosis patients have a high level of inflammation in their body which may simultaneously increase the risk of hypertension and lung issues. Certain eating patterns can tend to lower the inflammation levels in the body. C-reactive protein seems to be decreased in certain food pattern and this molecule is present in the bloodstream that determines the inflammation level of the body.

2. Power fats such as avocados, nuts, and fatty fish are rich in omega 3-fatty acids and they are also powerful anti-inflammatory eatables. There are power carbs such as whole grains, extra fiber,lentils, beans, protein, and antioxidants reduce the inflammation level.

3. Cut down red meat, empty carbs such as white rice, pasta, etc.

4. Refrain from foods with trans-fatty acids, such as commercially processed baked goods, like french fries, and margarine

5. Don’t go for tobacco, alcohol, and caffeine.

6. Avoid an excessive amount of calcium foods.

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Written ByDr. Praveen ChaudharyMBBS,PGD IN ULTRAASONOGRAPHY,Non invasive cardiology course,MD - MedicineInternal Medicine
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