What is Sarcoidosis?

Sarcoidosis is a chronic inflammatory disease that primarily affects the lungs and lymphatic system, but it can involve any part of the body. The hallmark feature of the disease is the formation of granulomas, small clumps of immune cells that form as a reaction to chronic inflammation.
Over time, if these granulomas persist, they can interfere with normal tissue function, leading to fibrosis (scarring).

This disease is not contagious, meaning it cannot spread from person to person. It can, however, occur in people of all ages, though it most commonly affects adults between 20 and 40 years old.

Sarcoidosis is a rare inflammatory disease that can affect multiple organs in the body, primarily the lungs, lymph nodes, eyes, and skin. It occurs when abnormal clusters of inflammatory cells called granulomas form in these organs, leading to tissue damage and reduced organ function.
Although the exact cause of sarcoidosis remains unknown, it is believed to be related to an overactive immune response to an unknown trigger — possibly an infection, environmental factor, or genetic predisposition.

Epidemiology and Risk Factors

Sarcoidosis affects people worldwide but varies by region and ethnicity:

• More common in women than men.
• Higher prevalence in African American, Scandinavian, and Northern European populations.
• Often diagnosed between ages 20 and 50.
• Family history increases the risk.

Major Risk Factors

1. Genetic factors – Family history of sarcoidosis.
2. Environmental exposure – Dust, chemicals, or mold exposure.
3. Infections – Some bacterial or viral infections may trigger it.
4. Immune system dysfunction – Abnormal immune responses may cause granuloma formation.

Causes

The exact cause of sarcoidosis remains unknown, but several theories exist:

1. Immune system reaction – The immune system overreacts to an unknown substance, forming granulomas.
2. Infectious triggers – Bacteria such as Mycobacterium tuberculosis or Propionibacterium acnes might stimulate sarcoidosis.
3. Environmental factors – Exposure to certain chemicals, insecticides, or dust may trigger the disease.
4. Genetic susceptibility – Certain genes may make individuals more prone to developing sarcoidosis.

Scientists believe that both genetic predisposition and environmental exposure play a combined role in the onset of the disease.

Commonly Affected Organs

Sarcoidosis can involve any organ, but it most frequently affects:

1. Lungs – In over 90% of cases, causing breathing problems.
2. Lymph nodes – Particularly in the chest area.
3. Skin – Rashes, bumps, or discolored patches.
4. Eyes – Inflammation leading to blurred vision or pain.
5. Liver and spleen – Enlargement and mild dysfunction.
6. Heart – Abnormal heart rhythms or heart failure (in rare cases).
7. Nervous system – Numbness, weakness, or paralysis in severe cases.

Symptoms

Symptoms of sarcoidosis vary depending on which organs are affected. Some people may have no symptoms at all, while others experience chronic illness.

General Symptoms

• Fatigue or extreme tiredness
• Fever and night sweats
• Unexplained weight loss
• Loss of appetite
• General weakness

Lung Symptoms (Pulmonary Sarcoidosis)

• Persistent dry cough
• Shortness of breath
• Chest pain or discomfort
• Wheezing

Skin Symptoms

• Red or purple bumps, especially on the shins (erythema nodosum)
• Raised scars or patches
• Skin discoloration or ulcers

Eye Symptoms

• Blurred vision
• Eye pain or redness
• Light sensitivity (photophobia)

Heart Symptoms

• Irregular heartbeat (arrhythmia)
• Palpitations
• Chest pain or fainting

Nervous System Symptoms

• Headaches
• Facial paralysis (Bell’s palsy)
• Seizures or confusion (in severe cases)

Stages of Pulmonary Sarcoidosis

Doctors often classify lung sarcoidosis into four stages based on chest X-ray findings:

1. Stage 0: Normal chest X-ray (no signs in lungs or lymph nodes).
2. Stage 1: Enlarged lymph nodes in the chest, but lungs are normal.
3. Stage 2: Both lymph nodes and lungs are affected.
4. Stage 3: Lung involvement only, with no lymph node enlargement.
5. Stage 4: Pulmonary fibrosis (scarring of lung tissue).

Diagnosis

1. Medical History and Physical Examination

• Detailed assessment of symptoms and organ involvement.
• Physical exam for swollen lymph nodes or skin lesions.

2. Imaging Tests

• Chest X-ray: Detects enlarged lymph nodes or lung involvement.
• CT Scan: Provides detailed lung and organ images.
• MRI or PET Scan: Used for heart or brain sarcoidosis.

3. Laboratory Tests

• Blood tests: To check calcium levels, liver function, and inflammatory markers.
• Angiotensin-converting enzyme (ACE) test: Often elevated in sarcoidosis.

4. Biopsy

• A tissue sample from affected organs (lungs, skin, or lymph nodes) confirms granuloma formation.

5. Pulmonary Function Test

• Measures how well lungs are working.

6. Eye Examination

• To detect inflammation or other eye complications.

Complications

• If not treated properly, sarcoidosis can lead to severe organ damage.
• Common Complications Include:
• Lung fibrosis (scarring leading to breathing difficulties)
• Pulmonary hypertension
• Heart failure due to cardiac sarcoidosis
• Vision loss from chronic eye inflammation
• Kidney stones or renal failure due to high calcium levels
• Neurological problems from nerve involvement

Treatment

There is no permanent cure for sarcoidosis, but treatment helps manage symptoms and prevent organ damage. Many patients recover without long-term problems.

1. Medications

• Corticosteroids
• Prednisone is the most common drug used.
• It reduces inflammation and helps shrink granulomas.
• Long-term use requires monitoring for side effects such as weight gain, diabetes, and osteoporosis.

Immunosuppressive Drugs

• Methotrexate
• Azathioprine
• Leflunomide
• Mycophenolate mofetil
• Biologic Agents
• In severe or resistant cases, TNF-alpha inhibitors (like infliximab or adalimumab) are used to control inflammation.

Other Medications

• Hydroxychloroquine – Useful for skin and joint symptoms.
• NSAIDs – For pain and inflammation relief.

3. Oxygen Therapy

• For patients with advanced lung involvement or breathing problems.

4. Organ Transplant

• In very severe cases, a lung or heart transplant may be required.

Lifestyle and Home Remedies

Lifestyle changes can complement medical treatment and improve quality of life.

Tips for Managing Sarcoidosis:

1. Quit smoking – Smoking worsens lung function.
2. Eat a balanced diet rich in fruits, vegetables, and whole grains.
3. Stay active – Gentle exercise can improve breathing and strength.
4. Avoid dust and chemicals that can irritate lungs.
5. Get regular check-ups – Monitor organ function regularly.
6. Protect your eyes by wearing sunglasses outdoors.
7. Manage stress – Yoga or meditation can help reduce inflammation indirectly.

Prevention

• Avoid environmental triggers like dust, mold, and chemicals.
• Maintain a healthy immune system through diet and rest.
• Avoid smoking and secondhand smoke.
• Seek early medical help if respiratory or skin symptoms appear.
• Follow treatment plans to prevent relapses.