Sarcoidosis – Causes, Symptoms and Treatment
Sarcoidosis is an inflammatory disease in which small clusters of inflammatory cells (granulomas) form in various organs, most commonly the lungs and lymph nodes.
Things worth knowing about "Sarcoidosis"
Sarcoidosis is an inflammatory disease in which small clusters of inflammatory cells (granulomas) form in various organs, most commonly the lungs and lymph nodes.
What is Sarcoidosis?
Sarcoidosis is a systemic inflammatory disease characterized by the formation of small clusters of inflammatory cells known as granulomas in various organs of the body. It is also referred to as Boeck disease or Boeck sarcoid. While granulomas can develop in virtually any organ, the lungs, lymph nodes, skin, eyes, and liver are most commonly affected.
In many cases, sarcoidosis is mild or even asymptomatic and resolves on its own. However, in some individuals it can become chronic and lead to lasting organ damage.
Causes
The exact cause of sarcoidosis has not yet been fully determined. It is believed that a combination of genetic predisposition and external triggers – such as certain bacteria, viruses, fungi, or environmental substances – prompts an exaggerated immune response, which in turn leads to the formation of granulomas.
- Genetic predisposition (familial clustering has been observed)
- Infectious triggers (e.g., mycobacteria, Propionibacterium acnes)
- Environmental factors (e.g., organic dust, mold, occupational exposures)
- Dysregulation of the immune system
Symptoms
The symptoms of sarcoidosis vary widely depending on which organs are affected. Many individuals initially experience no or only non-specific complaints.
General Symptoms
- Fatigue and exhaustion
- Fever and night sweats
- Unintentional weight loss
Lungs (most common manifestation)
- Dry cough
- Shortness of breath (dyspnea)
- Chest pain or tightness
Other Possible Manifestations
- Skin: Reddish nodules (erythema nodosum), lupus pernio
- Eyes: Uveitis, redness, light sensitivity, visual disturbances
- Heart: Cardiac arrhythmias, rarely heart failure
- Nervous system: Facial nerve palsy, headaches
- Joints: Joint pain and swelling
Diagnosis
Diagnosing sarcoidosis can be challenging because its symptoms overlap with many other conditions. It is often considered a diagnosis of exclusion. Common diagnostic methods include:
- Chest X-ray and CT scan: To detect enlarged lymph nodes or lung abnormalities
- Blood tests: Elevated angiotensin-converting enzyme (ACE) levels, calcium levels, inflammatory markers
- Tissue biopsy: Microscopic confirmation of granulomas from lymph nodes or lung tissue
- Bronchoalveolar lavage (BAL): Analysis of cells in the airways
- Eye examination: To detect or rule out ocular involvement
- ECG and cardiac imaging: When cardiac involvement is suspected
Treatment
Not all cases of sarcoidosis require treatment. When symptoms are mild and vital organs are not at risk, a watchful waiting approach is often recommended. Treatment becomes necessary when important organs are significantly affected or the disease is progressing.
Pharmacological Treatment
- Corticosteroids (e.g., prednisone): The first-line treatment to suppress inflammation
- Immunosuppressants (e.g., methotrexate, azathioprine): Used in chronic cases or when corticosteroids are not tolerated
- Antimalarials (e.g., hydroxychloroquine): Particularly useful for skin and joint involvement
- Biologics (e.g., infliximab): Reserved for treatment-resistant cases
Non-Pharmacological Measures
- Regular medical follow-up and monitoring
- Breathing exercises and physiotherapy for pulmonary involvement
- Avoidance of known triggers (e.g., dust exposure, smoking)
Prognosis
In approximately 60–70% of patients, sarcoidosis resolves spontaneously within two to five years. However, a proportion of patients develop a chronic form of the disease. Serious complications such as pulmonary fibrosis, cardiac arrhythmias, or vision loss are rare but possible. Regular follow-up care is therefore essential.
References
- Iannuzzi MC, Rybicki BA, Teirstein AS. Sarcoidosis. New England Journal of Medicine. 2007;357(21):2153–2165.
- Statement on Sarcoidosis. Joint Statement of the American Thoracic Society (ATS), the European Respiratory Society (ERS) and the World Association of Sarcoidosis and Other Granulomatous Disorders (WASOG). American Journal of Respiratory and Critical Care Medicine. 1999;160(2):736–755.
- Valeyre D, Prasse A, Nunes H, et al. Sarcoidosis. The Lancet. 2014;383(9923):1155–1167.
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