What happens with sarcoidosis
A granuloma is a collection of immune cells that try to fence off the intended irritant. In sarcoidosis, such nodules form without visible infection and can appear in several organs simultaneously. A small number of granulomas usually do not interfere with the functioning of the organ and resolve over time. If the inflammation lasts for a long time, scar tissue forms in place of the granulomas: in the lungs this leads to fibrosis and a decrease in their volume. Doctors distinguish between an acute course, which often ends in recovery, and a chronic course, which requires many years of observation.
- Sarcoidosis of the hilar lymph nodes
- Pulmonary sarcoidosis with changes in lung tissue
- Löfgren's syndrome - acute onset with fever, joint pain and erythema nodosum
- Sarcoidosis of the skin
- Eye damage - uveitis
- Sarcoidosis of the heart and nervous system - rare but dangerous forms
Causes and risk factors
No single cause of sarcoidosis has been found. The modern idea is this: in a person with a certain hereditary feature of the immune system, an excessive response to an external antigen is triggered, and the inflammation does not subside as usual. Inorganic dust, some microorganisms and occupational hazards are discussed as a trigger factor. The disease often begins in young and middle age. Sarcoidosis is not transmitted from person to person, so the patient’s loved ones are not threatened by infection, and cases in one family are explained by common heredity and living conditions.
- Age from 20 to 50 years
- Cases of sarcoidosis in relatives
- Working with metal, wood, construction dust
- Exposure to agricultural dust and mold
- Work as a firefighter and in hazardous industries
Symptoms
Often, sarcoidosis does not cause any complaints and is detected during preventive fluorography: the image shows enlarged lymph nodes of the roots of the lungs. If there are symptoms, they are often nonspecific - weakness, fatigue, sweating, low fever. When the lungs are affected, a dry cough, shortness of breath and chest discomfort appear. Löfgren's syndrome begins suddenly: the ankle joints hurt and swell, painful red nodes appear on the shins, and the temperature rises. Manifestations from the eyes, skin and heart can occur without changes in the lungs.
- Dry cough and shortness of breath on exertion
- Weakness, fatigue, sweating
- Low temperature, weight loss
- Pain and swelling of the ankle joints
- Red painful nodes on the legs
- Redness of the eyes, photophobia, blurred vision
- Palpitations, interruptions in heart function
Diagnostics
The main objectives of the examination are to confirm the presence of granulomas, exclude diseases with a similar picture, especially tuberculosis, lymphoma and cancer, and assess which organs are involved. The basis is a chest CT scan. The diagnosis is usually confirmed histologically: a tissue sample is obtained by bronchoscopy, ultrasound-guided lymph node biopsy, or from an accessible lesion on the skin. Without a biopsy, the diagnosis is valid only in typical cases, for example with Löfgren's syndrome. All patients have their lung function, calcium levels, kidney and liver function checked, an ECG done and referred to an ophthalmologist.
- X-ray and CT scan of the chest
- Spirometry and study of lung diffusion capacity
- Bronchoscopy with biopsy, if necessary, endosonography
- Blood and urine calcium, creatinine, liver function tests
- ECG, according to indications - echocardiography and MRI of the heart
- Examination by an ophthalmologist with a slit lamp
- Testing to exclude tuberculosis
Treatment and observation
Not every patient with sarcoidosis needs medication. If the patient is asymptomatic and has preserved lung function, the doctor chooses observation with control CT and spirometry, since the disease often regresses on its own. Treatment is indicated for severe symptoms, decreased lung function, damage to the heart, eyes, nervous system, kidneys, or high calcium levels. The main drugs are systemic glucocorticosteroids; if they need to be taken for a long time or are poorly tolerated, immunosuppressive drugs are added. The regimen and duration are determined only by the doctor. It is important for patients to stop smoking and avoid dust.
- Observation with control of CT and lung function in mild cases
- Systemic glucocorticosteroids
- Immunosuppressive and biological drugs for severe forms
- Treatment of eye manifestations by an ophthalmologist
- Smoking cessation and protection from industrial dust
- Taking vitamin D and calcium only after consultation with your doctor