SARCOIDOSIS

 

Sarcoidosis is a rare disease that often occurs in the lungs and lymph nodes, but it can occur in almost any organ.

Sarcoidosis can effect the lungs by causing lumps of inflammation called granulomas.  Although these granulomas usually heal up on their own, sometimes they can persist and cause chronic changes to the lungs in the form of scar tissue.  This scar tissue reduces the elasticity of the lungs and can lead to pulmonary fibrosis.  This reduced elasticity reduces the volume of the lungs making the patient have to breath faster to compensate for the reduced volumes.  

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CAUSES

The medical community does not fully understand what causes Sarcoidosis.  The thought is that there is an underlying genetic component that makes the lungs reactive to certain stimuli that cause these inflammatory episodes.

SYMPTOMS

Most people do not have symptoms.  If someone does become symptomatic their symptoms may include:

  • Shortness of breath, especially with exertion

  • Dry cough that won't go away

  • Chest pain

  • Wheezing

Other non-pulmonary symptoms may include:

  • Extreme tiredness (fatigue)

  • Fever

  • Inflammation of the eyes and pain, burning, blurred vision, and light sensitivity

  • Night sweats

  • Pain in the joints and bones

  • Skin rashes, lumps, and color changes on face, arms, or shins

  • Swollen lymph nodes

  • Weight loss

DIAGNOSIS

Diagnosis begins with a proper history and physical exam.  Additional tests may include:

  • Chest X-ray:  This imaging test takes a picture of the heart and lungs.  Sarcoidosis may show as an increased tissue density resulting from areas of inflammation or fibrotic changes.

  • CT scan:  This imaging test uses X-rays and computer technology to make horizontal images (called slices) of the body. A CT scan may be ordered if the chest X-ray showed anything that warranted further investigation.  CT scans provide more detailed information.

  • Pulmonary function tests:  This test can be performed in the office.  This test measures several different aspects of the lungs.  Sarcoidosis will often show reduced lung volumes, and if more advanced will additionally show decreased gas exchange.

  • Arterial blood gas:  This test can assess how well the lungs get oxygen into the blood stream and carbon dioxide out of the blood stream.  As Sarcoidosis progresses an impairment of gas exchange may be noted in this test.

  • Bronchoscopy:  A long, thin, flexible tube (bronchoscope) with a light at the end is put down the throat and into the lungs. This allows the physician to directly view different parts of the lungs.  If the physician sees something that warrants further investigation, they can obtain a tissue sample called a biopsy.  This sample can then be sent to pathology where it will be tested.

  • Lung biopsy:  A small piece of tissue, cells, or fluid from the lungs is taken out and checked under a microscope.

  • Sarcoidosis is often diagnosed when other lung disorders are ruled out.

  • Bronchoalveolar lavage:  During a bronchoscopy the physician may use sterile saline to cleanse areas of the lung.  This saline is then sucked back out and can be sent for testing.  The saline carries out cells from the lower respiratory tract. These cells can be checked under a microscope to help find inflammation and infection. The test can help rule out certain causes.

TREATMENT

Treatment is generally done to control symptoms:

  • Steroid:  These medications help to reduce inflammation.  They can be taken by mouth, aerosolized, and intravenously. 

  • Methotrexate:  This medication belongs to a class of medications that suppress immune activity and hinder the growth of certain types of cells.  This may be used if steroids don't work.

  • Oxygen therapy:  If the disease progresses to a point where it significantly impairs gas exchange, oxygen therapy may be used to keep oxygen saturations (SPO2) within an appropriate range.

  • Pulmonary rehab:  In more advanced cases where the lungs show moderate to severe impairment, the physician may order pulmonary rehab.  Pulmonary rehab is conducted in a fitness center/gym environment and is overseen by healthcare professionals.  These healthcare professionals help create an individualized workout routine for each patient to optimize their cardiopulmonary function.

For patients with milder symptoms, maintaining a healthy lifestyle is key.  Staying active and eating a healthy diet will go a long way to minimizing symptoms.

SARCOIDOSIS EDUCATION VIDEO