Sarcoidosis (Besnier-Boeck-Schaumann disease) is an inflammatory disease affecting multiple organs in our body. In sarcoidosis, tiny abnormal growths of inflammatory cells (granulomas) develop. These granulomas can occur in many parts of our body, mainly affecting the lungs and intrathoracic lymph nodes. We can notice these granulomas in and around the eyes, skin, liver, heart, and brain. Granuloma in organs causes organ inflammation and various other manifestations.
What are the causes of sarcoidosis?
The exact cause of sarcoidosis is still unknown. Some researcher suggests it may be a type of autoimmune disease. It can be due to our body’s abnormal immune reaction to any trigger, such as bacterial or viral infection or chemicals.
Sarcoidosis is more common in women than men. Afro-Americans and people with a family history also have a higher predilection for the disease. It rarely affects children.
What are the signs and symptoms of sarcoidosis?
Signs and symptoms of sarcoidosis usually appear in adults (aged between 20 to 40 years). Some people do not experience any symptoms, and the disease persists throughout their life asymptomatically. The signs and symptoms vary according to the involvement of the organs. However, general symptoms of sarcoidosis are:
- Mild to moderate fever
- Fatigue and malaise
- Joint pain and muscle discomfort
- Dryness in mouth and throat
- Frequent nosebleeds
- Skin lesions and rashes
- Abdominal swelling and discomfort
- Lung symptoms: lungs are the main organ affected by sarcoidosis. It starts as inflammation of the alveoli (alveolitis). Alveolitis either subsides gradually or may progress into granuloma. The patient may experience:
- Persistent cough
- Shortness of breath
- Tightness or discomfort in the chest area
- Chest pain
- Granulomas in the lung can cause narrowing of the airways, lymph nodes enlargement, inflammation, and fibrosis of lung tissues.
- Skin symptoms: These symptoms may present in the sarcoidosis patients:
- Painful reddish patches or nodes
- Hair loss
- Subtle painless deep scars
- Eye symptoms: Sarcoidosis can affect any part of the eye (eyelids membrane, sclera, cornea, iris, retina, or lens). People may feel:
- Dry and itchy eyes
- Blurred vision
- Pain or burning sensation in the eyes
- Long-standing sarcoidosis may cause dry eyes, glaucoma, cataracts, or even blindness in some patients.
- Nervous system symptoms: Sarcoidosis rarely affects our nervous system. Symptoms of neurological involvement include:
- Headaches
- Meningitis
- Seizures
- Nerve tissues inflammation and degeneration cause weakness, pain, sensitivity to touch, and numbness in the face, arms, and legs.
- Liver symptoms: Liver involvement in sarcoidosis is quite common (about 50% to 80%). Granulomas in the liver rarely show noticeable symptoms.
- Heart symptoms: Sarcoidosis rarely shows heart-related manifestation. Sarcoidosis granuloma can affect any part of the heart. It can have the following symptoms:
- Chest pain
- Arrhythmias
- Inflammation of the lining of the heart (pericarditis)
- Rarely heart failure
- Kidney stones
How to diagnose sarcoidosis?
The signs and symptoms of sarcoidosis are similar to many diseases. So, to differentiate sarcoidosis, a complete physical examination and thorough patient history are a must. Diagnosis of sarcoidosis includes:
- Detailed medical history of occupational and environmental exposure, family history, and medication history
- Complete blood analysis
- Chest X-rays for a complete picture of lungs, heart, and surrounding lymph nodes
- Bronchoscopy
- CT-Scan for detailed information on lungs and lymph nodes
- Pulmonary function tests
- Biopsy of granulomas and fibrosis
- Electrocardiogram
- PET-scan
Stages of sarcoidosis
Sarcoidosis can affect any organ in our body, but it commonly affects our lungs. The four stages of pulmonary sarcoidosis are:
- Stage 1: Swollen or enlargement of the lymph nodes surrounding the lymph and heart, but no infiltrations (blood, pus, or protein substance) in the lungs
- Stage 2: Enlarged lymph nodes surrounding the heart and lungs, and infiltrates are also present in the lungs
- Stage 3: Swelling of the lymph nodes is not evident, but infiltrates are present in the lung
- Stage 4: The patient may have pulmonary fibrosis and scarred lung tissues
Treatment of sarcoidosis
No definite treatment regimen is available for sarcoidosis. Its symptoms gradually disappear with time. Maintaining good health practices also alleviates mild symptoms. Medicines relieve symptoms, reduce the inflammation of the tissues, and reduce the impact of granulomas. Medications are:
- Corticosteroids: Health care providers most commonly prescribe prednisone to treat sarcoidosis. It suppresses the immune response and subsides inflammation.
- Alternative treatments: for the treatment of other organs’ involvement:
- Disease-modifying antirheumatic drugs (DMARDs)
- Antimalarial agents
Sarcoidosis has a better prognosis, as it generally improves its own. It rarely shows complications. If you are experiencing any symptoms that do not subside, immediately contact your doctor for proper treatment.
Dr. Gaurav Jain | Consultant – Internal Medicine | Dharamshila Narayana Superspeciality Hospital, Delhi