SARCOIDOSIS

INTRODUCTION

Sarcoidosis (SAR-coy-DOH-sis) is a complex disease that can produce many 
different symptoms. It often affects the lungs, skin, joints, and eyes, 
but it can involve almost any organ or tissue in the body. Not all cases 
of sarcoidosis are the same. Some people have many symptoms, while 
others have only a few. Although sarcoidosis can go away by itself, it 
generally will last throughout a person's life. However, it can be 
controlled with medications.

This booklet contains information about sarcoidosis and its treatment. 
It is important to recognize the symptoms of sarcoidosis because it can 
be mistaken for other diseases.

HOW DOES SARCOIDOSIS AFFECT PEOPLE?

Sarcoidosis is generally a chronic disease, lasting for several years or 
for a lifetime. With some people it begins with no symptoms at all and 
is discovered through a routine chest x-ray. With other people it begins 
with a few symptoms and gradually progresses to become more widespread 
and serious. With still others it begins with many symptoms appearing 
either very suddenly or slowly over a period of time.

Some people may have symptoms that only last a few months. These 
symptoms generally disappear and usually do not recur. This is a form of 
sarcoidosis sometimes referred to as Lofgren's (LUF-grin's) syndrome, 
and symptoms may include:
lung problems eye problems red, painful skin sores joint pain and
stiffness low-grade fever enlarged lymph glands, liver, and spleen,
which may not produce any noticeable symptoms 

WHAT ARE THE SYMPTOMS OF SARCOIDOSIS?

A major problem in sarcoidosis is the formation of small, hot, and 
swollen nodules (hard bumps) in different areas of the body. These 
nodules are called granulomas (gran-u-LOH-mahs). They frequently form in 
the lungs, eyes, and skin. The lymph glands, liver, spleen, muscles, 
bones in the hands or feet, joints, heart, and almost any other part of 
the body may also be involved (see Figure 1).

Lung Problems

Sarcoidosis most commonly affects the lungs. Breathing or lung problems 
can occur when granulomas form within this organ. Symptoms can include 
dry cough, shortness of breath, and/or chest pain. However, most people 
experience little or no breathing problems. And lung problems generally 
go away on their own. Fortunately, few people develop severe lung 
disease.

Eye Problems

Besides the lungs, sarcoidosis frequently affects the eyes. Inflammation 
or swelling of the iris (colored portion of the eye) can occur. This is 
called iridocyclitis (EER-id-o-SYK-ly-tis). Symptoms include redness of 
the eye, pain, and sensitivity to light. If not treated properly, 
blindness may result. Tear glands also can become inflamed, causing 
sicca syndrome (dry eyes). Glaucoma - pressure inside the eye that can 
result in vision loss - may also occur.

3) An unidentified toxic substance. 
4) An unknown environmental cause. 
5) An inherited or genetic cause.

HOW IS SARCOIDOSIS DIAGNOSED?

Doctors have several ways of detecting sarcoidosis. During the medical 
history and physical exam, doctors often will discover enlarged, tender 
lymph glands and a dry cough. If eye problems are suspected, a complete 
eye examination can be done by an ophthalmologist (eye specialist).

In most cases, chest x-rays will detect nodules in the lungs. These are 
found even in people who have no obvious symptoms. X-rays can detect 
other abnormal signs in the lung and chest resulting from sarcoidosis.

Another useful examination involves the removal (under anesthesia) of a 
tiny piece of tissue from the skin sores, lymph nodes, or lungs. This 
procedure is called a biopsy (BY-op-see). After the piece of tissue is 
removed, it is examined under a microscope to see if granulomas are 
present.

Blood tests are another way of determining whether or not body organs 
are functioning properly as well as ruling out other diseases. The ACE 
(angiotensin converting enzyme) test is a special blood test used in 
diagnosing sarcoidosis.

HOW IS SARCOIDOSIS TREATED?

People with the acute form of sarcoidosis may need treatment to relieve 
discomfort from symptoms such as skin sores, joint inflammation, and 
muscle pain. The treatment for joint inflammation includes exercise, 
joint protection, and medication to reduce the inflammation. The 
medications used to treat joint inflammation are called nonsteroidal 
anti-inflammatory drugs (NSAlDs).

For those people who have severe symptoms or whose disease has spread to 
internal organs, corticosteroids (KOR-ti-co-STARE-oids) may also be 
needed. Corticosteroids (such as prednisone) are medications that act 
like cortisone, which is a hormone the body naturally produces. 
Corticosteroids reduce pain and inflammation and suppress the formation 
of granulomas. They are the most effective medications for treating 
sarcoidosis. 

Corticosteroids are administered in one of three ways, depending upon 
the affected area of the body. These medications generally are given by 
mouth to reduce inflammation and the formation of internal granulomas. 
To relieve skin problems, physicians prescribe steroid cream. And 
corticosteroid drops are useful for treating eye problems.

Physicians generally prescribe high dosages of corticosteroids when 
first treating someone with sarcoidosis. Once the medication begins to 
work, it is decreased to the smallest amount possible that is still 
effective.

Treatment with corticosteroids is generally administered over a period 
of several years or throughout a person's lifetime. If the drugs are 
stopped, the illness may reappear. Therefore, people who no longer are 
being treated should be sure to have frequent medical checkups, since 
granulomas can reappear.

Note: People who take corticosteroids should NEVER decrease or stop them 
abruptly. Stopping the drug must be done slowly, with close supervision 
by a doctor. This is because the body does not produce its own cortisone 
when corticosteroid medications are present. If the drugs were stopped 
abruptly, there would be no cortisone present in the body. This could be 
fatal. When corticosteroids are stopped gradually, over a period of 
weeks to months, it gives the body time to adjust and start producing 
cortisone on its own again. Patients taking corticosteroids should carry 
a card or preferably wear a bracelet indicating that they are taking a 
corticosteroid.

Because corticosteroids are strong drugs and similar to cortisone, they 
may have many side effects. Anyone who is about to receive 
corticosteroids should discuss the side effects and benefits of these 
drugs with their doctor before treatment is started.

SUMMARY

Sarcoidosis is a complex illness. Its symptoms vary and can occur in 
almost any part of the body. Most people who have the sudden, short-term 
form of sarcoidosis often improve without major treatment. However, if 
sarcoidosis continues for a longer time, the disease usually spreads to 
more parts of the body and can be more severe. This condition usually 
requires treatment with corticosteroids.

With early diagnosis and proper treatment, there can be considerable 
relief from the symptoms of sarcoidosis and restored function of the 
affected organs.