Sarcoidosis is a disease that can affect any organ in the body. The lung is the most common organ involved with sarcoidosis. The eyes, skin, and lymph glands are also commonly involved. Sarcoidosis can also affect the liver, spleen, brain, nerves, heart, bones, muscles, and joints. Sarcoidosis can also cause generalized body symptoms such as fever, weight loss, night sweats, and fatigue.
Symptoms
Symptoms caused by sarcoidosis depend on which organs are involved. For example, a sarcoidosis patient with lung involvement may experience symptoms of shortness of breath, cough, chest pain, and wheezing. A patient with eye involvement from sarcoidosis would be expected to experience eye symptoms such as visual disturbances, pain, or redness in the eyes. Sarcoidosis affects various organs of the body by causing a specific reaction in body tissues called granulomas. Granulomas can only be seen under the microscope when a body tissue that is affected by sarcoidosis is biopsied. Diagnosis
To diagnose a patient with sarcoidosis, physicians usually biopsy tissue which they think is affected by sarcoidosis. This tissue is examined under the microscope for the presence of granulomas. If granulomas are found under the microscope, this does not yet make the diagnosis of sarcoidosis. The reason for this is that there are several diseases other than sarcoidosis which can cause granulomas in tissues. These diseases include tuberculosis, fungal diseases, a reaction to a metal called beryllium, diseases related to certain environmental exposures, and other diseases. Therefore, to make the diagnosis of sarcoidosis, the physician not only needs to identify granulomas in an affected tissue but also must exclude other diseases that could cause granulomas. Physicians therefore call sarcoidosis "a diagnosis of exclusion". Sometimes a physician will make the diagnosis of sarcoidosis without biopsying tissue. This occurs in special situations when there is a combination of patient symptoms plus certain patterns on chest x-ray which are almost only found in patients with sarcoidosis. In these instances, the physician may feel that the diagnosis of sarcoidosis is so likely that the patient should not have to undergo a biopsy procedure. Causes
The cause of sarcoidosis is unknown. Various theories about the cause of sarcoidosis have been proposed over the century. However, none of them has been proven. Proposed causes of sarcoidosis have included occupational exposures, environmental exposures, viruses, tuberculosis, other infectious agents, and genetic causes (related to heredity). Presently the National Institute of Health is conducting a multicenter study at ten clinical centers around the United States in order to determine the cause of sarcoidosis. The Medical University of South Carolina is one of the ten centers participating in this study. Prognosis
Usually sarcoidosis has a very good prognosis. Eighty percent (4 out of 5) of patients with sarcoidosis will be permanently cured or stabilized within two to five years after their diagnosis. Twenty percent of patients will develop progressive disease. At the present time, although there are some clues as to who will develop progressive disease, it is not possible to definitively predict which patients will have this course. Death from sarcoidosis is rare. It usually occurs in patients with the progressive form of disease, and usually does not occur for at least ten to thirty years following diagnosis. Treatment
The treatment of sarcoidosis has not yet been standardized. Corticosteroids are the primary medication used for the treatment of sarcoidosis. Many times no therapy is given for sarcoidosis because, although Corticosteroids have been shown to be of benefit in the short term, they usually are not of benefit over the long term. Since Corticosteroids have many side effects, physicians sometimes believe that the "therapy" with Corticosteroids may be worse than the disease. The physician must use his expert judgment to decide which patients should be treated and which should be followed without therapy to see if they improve on their own. Other medications are available for the treatment of sarcoidosis. These medications include hydroxychloroquine (Plaquenil), azathioprine (Imuran), methotrexate, chlorambucil, and several other medications. All of these medications have potentially severe side effects as well. In patients with end stage lung, heart, or liver disease, transplantation has been performed. Transplantation should be viewed as a procedure of last resort. For More Information
If you have questions about sarcoidosis, would like more information about the Sarcoidosis Center, or would like to participate in sarcoidosis studies, contact MED-U-NURSE or email Dr. Marc A. Judson at judsonma@musc.edu. |
