Sarcoidosis: Symptoms, Causes, Risks, Complications, Diagnosis, Treatment, Prevention and Prognosis

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illustration which present the disease Sarcoidosis

Overview

Sarcoidosis is a type of disease that is inflammatory that can greatly affect many vital organs in the body.

As the inflammatory process occurs, the presence of nodes, lumps or masses called granulomas, are formed on the organs especially the lymph nodes, spleen, lungs, kidneys, eyes, heart, the brain and even the skin. Most cases of Sarcoidosis tend to go away in time without treatment, but sometimes it leaves scars that can affect the functions of the organs.

Sarcoidosis which means flesh-like was known as Hutchinson’s disease before, because of the eruptions of granulomas on the skin caused by an illness.

Symptoms

The symptoms of this disease, Sarcoidosis, is different from person to person. Some may have complaints of fatigue, frequent coughing accompanied by episodes of shortness of breath. Others may have:

  • Presence of red patches of rashes on the skin of the patient.
  • Enlarged lymph nodes in the neck, groin area, and underarms.
  • Painful joints are felt either at rest or not.
  • Weight loss is apparent due to irritation of the throat or airway.
  • Formation of cysts on the bones especially on the hands.
  • Liver enlargement is seen upon check-up by x-ray.
  • Pericarditis: inflammation is present in the layer of the heart called pericardium. It may cause irregular or missed heartbeats.
  • Chest pains and wheezing is present
  • Abdominal swelling due to the inflammation of tissues in the stomach
  • Loss of hearing and seizures
  • Dry eyes accompanied by itchiness, pain and eventually may result in Vision loss.
  • Psychiatric disorders may also be a symptom due to the growth of granulomas in the nervous system.

The symptoms may occur suddenly and will subside abruptly or slowly. Patients will not even know that they have Sarcoidosis unless they will have a check-up.

Causes

The cause for having Sarcoidosis is still unknown today. Some doctors say that the cause is due to an autoimmune disease that the body attacks its self. The T cells in the immune system were found to play a significant role in Sarcoidosis, the CD4 cells with the interleukin-2 are found on the organ that is affected by the disease.

The pulmonary Sarcoidosis is said to have a CD4+ and CD8+ ratio of about 3.5 the lavage of the bronchoalveolar fluid. The tumor necrosis factor or TNF and its receptors are also elevated, it is said to be that the tumor necrosis factor is aiding in the inflammation in this disease. Also, the B cells and T cells move actively with the production of the immunoglobulin. All the cells that have been involved in the inflammation on the site are the all elevated significantly.

In addition to T cells, B cells also play a role, the B cells are found in the pulmonary system where the scarring occurs. There is evidence of the B-cell being hyperactive with immunoglobulin production.

Risk Factors

People who are at risk of Sarcoidosis are women aged 20 to 40 years old and they are more common with African- Americans or those who are Irish, German, Scandinavian or Puerto Rican.  Most of the Americans affected by the disease are not aware or has not been diagnosed with the disease.

Although there is no evidence that Sarcoidosis is not hereditary the researchers found out that the disease is not contagious, so it cannot be passed to other family members or even friends.

Complications

Most of the People who have Sarcoidosis does not have any complications but if the condition persists and lasts up to years, the patient may have complications within the affected organ like:

  • Cataract – The development of cataracts may be one of the complications involving the eyes of the patient. The eyes of the patient have a distinct cloudy appearance where there are proteins building on the lens of the either of the eyes.
  • Glaucoma – The growth of granuloma in the eyes may have a detrimental effect on the optic nerve which is responsible for sending a signal to the brain and that may cause Glaucoma.
  • Abnormal heartbeats – The person may experience having skipped beats of the heart because of the growth of the Sarcoidosis on the tissues of the heart.
  • Kidney diseases – these include the infection in the kidney or growth of a tumor can lead to end-stage renal disease if the disease is not treated. Kidney failure will happen if the growth of the granuloma is not treated.
  • Lung infections – The lungs are prone to bacterial and viral infection due to the growth of the disease that is not controlled. Scarring of the lining of the lungs will mostly hinder the patient to breathe properly.
  • Infertility –This will result if the Sarcoidosis is present in the reproductive system of the person.
  • Facial numbness or any part of the body is alarming – Aside from Sarcoidosis numbness on any part of the body might also indicate stroke that s potentially life-threatening.

If the person is experiencing palpitations, chest pains, difficulty in breathing, sensitivity to light and numbness in certain areas of the body, the person needs emergent attention to address the problem.

Diagnosis

The disease itself is very challenging to diagnose just by a simple physical assessment.
The symptoms may be interpreted as a different disease like cancer or other common diseases.

To be able to properly diagnose Sarcoidosis the physician will perform a though assessment and check for rashes on the skin, palpate for the lymph nodes. The doctor will also listen to the heart sounds to be able to detect any abnormal rhythms present, lungs are also assessed to see if there are any crackles or wheezes in each lung.

After the physical assessment, the doctor will also order other confirmatory tests like:

Chest X-ray – The x-ray will help the doctor see the condition of the lung and also to see if any lymph nodes are swollen.

Blood test

The blood components help the doctor identify if there are any infections present inside the body by the level of white blood cells. The angiotensin-converting enzyme, protein, is also detected during blood tests.

Liver enzymes are also included in the test to see if the liver is functioning well if the Sarcoidosis is in the liver.

Pulmonary function test

This test measures the lungs capability when breathing if the lungs can facilitate the gas exchange. Most patients who have this disease have labored breathing because of the scarring of the tissues inside the lungs.

Gallium scanning

The patient is injected with a chemical, gallium-67, and after 2 days, the patient will undergo a scan to determine if some of the Gallium attached to the parts where the Sarcoidosis is present.

Slit-lamp examination

This is an examination that checks if the eye is affected by the Sarcoidosis. Visual impairment is the start of many problems involving Sarcoidosis.

Biopsy

The doctor will obtain a small sample of the tissue to be sent to the laboratory and get tested. Sarcoidosis is diagnosed if this test shows positive results.

Bronchoalveolar Lavage

A scope will be inserted into the throat of the patient and the procedure flushes out the lungs, the water that was flushed out will be sent to the laboratory to be tested if there are any cells that aids in the inflammatory process.

Treatment

As of now, there is no treatment available to cure the disease, Sarcoidosis usually goes away without any treatment. The doctors do prescribe medications to reduce the inflammation in the body especially if the affected organs are the lungs, heart, kidneys and the brain.

There are treatments for Sarcoidosis that aims to prevent the disease from going into the lungs, heart or any vital organs in the body. If the inflammation is serious, the doctors will prescribe corticosteroids to help reduce the swelling in the affected area.

Prevention

The cause of Sarcoidosis is not yet known, so to prevent this disease is not yet fully determined by the doctors. The doctors are focusing on the treatment of the patients who has this disease and they cited some examples:

Avoid smoking – Smoking can lead to many different types of diseases especially in the lungs and throat of the patients who are chronic smokers.

Avoid exposure to harmful chemicals – Inhaling fumes that are toxic to the health can also contribute to damaging the linings of the lungs.

If the patient suspects he or she has Sarcoidosis, he or she should seek medical help to determine the exact cause of the symptoms present.

Have a regular eye check-up to see if there are any growths inside the lenses or even in the optic nerves.

For women who have Sarcoidosis, have a regular check-up to your Ob-Gyne to determine treatments and ways to have a child, if the patient is planning to have a baby.

Have other family members involved in the treatment by providing support to the client.

Prognosis

The prognosis of patients having Sarcoidosis is good. The disease tends to be gone after two years with treatment or even without but if the patient has a chronic Sarcoidosis, he or she should seek medical treatment.  The outlook of Sarcoidosis depends on where the disease lies but generally, people lived a normal life during or after they have the disease.