Sarcoidosis


A comprehensive overview of sarcoidosis covering subjects like symptoms, diagnostics, research, causes and pictures
Sarcoidosis

Sarcoidosis


     Sarcoidosis is a disease manifested by coughing, choking, increased lymph nodes, especially those of the neck, the appearance of spots or red-purple nodules on the skin, pain and swelling in the joints, especially the hands and ankles, tearing, eye redness, blurred vision. The disease may occur at any age, especially among young people with ages between 20 and 40 years and is accompanied by the appearance of areas of inflammation areas in multiple organs, but most often the lungs.

     Diagnosis must follow several purposes:

  • obtain histological confirmation
  • assessment of the extent and severity of disease
  • assessment of stability or progression
  • determining the need for treatment

     Studying the natural history of disease show spontaneous resolution of disease in 2 / 3 of patients in the first 2 years after diagnosis (usually within the first months after onset, but may occasionally after longer periods).

     Chances are very high spontaneous healing stage I radiological and almost zero in stage IV.

     Among patients who have spontaneous remission or stabilize, only 2-8% will suffer a future reversal of the disease.

     Prognosis generally favorable for most patients with stage I, is reserved for those with stage II and III.

     Patients still have symptoms / signs at 2 years after diagnosis are considered to have chronic sarcoidosis.

     Negative prognostic factors in sarcoidosis are :

  • the dark race
  • onset after 40 years
  • submit events more than 6 months
  • type III and type IV Radiological
  • affecting more than 3 organs
  • extra pulmonary locations: pernio lupus, nerve damage, heart disease, chronic hypercalcem



Sarcoidosis clinical manifestations


     Considering the fact that sarcoidosis can affect practically any organ, the localization of the clinical manifestations vary accordingly. Most patients show impaired lung and of the space between the two lungs (the mediastinum). Other commonly affected organs are the liver, spleen, heart, eyes, skin, bones, joints and nervous system.


Typical sarcoidosis symptoms


     As with other inflammatory diseases, sarcoidosis can occur with general symptoms: fever, altered general condition, fatigue, pain in the limbs. Depending on the time evolution one can differentiate between acute and chronic form of sarcoidosis.

     Symptoms caused by sarcoidosis according to the affected organ:

  • Lymph nodes (90%): Inflammation
  • Lungs (95%): cough and dyspnea (rare)
  • Liver (50-70%): hepatomegaly, elevated transaminases
  • Spleen (50-70%): Splinomegaly, decreased erythrocyte, leukocyte and the platelet.
  • Heart (20-30%): Cardiac arrhythmia, poor functioning mitral valve, pericardial.
  • Eyes (5.10%): blurred vision, pain, photophobia
  • Skin (10-25%): Erythema, painful cutaneous nodules, red-blue color, and facial lumps of red-blue, with smooth
  • Kidneys (10%): Increases the amount of protein and calcium excreted in the urine (proteinuria and calciuria)
  • Bones (10%): The dissolution of the bone structures especially in the small bones of hands and feet (osteolysis)
  • Joints (10%): The inflammation of multiple joints (arthritis), especially the knee joints, hands, etc..
  • Nervous system (10%): paralysis, headache, intracranial hypertension, seizures.

Acute sarcoidosis


     Acute sarcoidosis begins abruptly, most often with high fever and altered general state, plus specific symptoms depending on the organs affected. Although the evolution of acute sarcoidosis is severe, the prognosis remains favorable.

     A special form of acute sarcoidosis is the syndrome Lofgren. Typical clinical manifestations in this case, besides the fever that begins to grow sharply, are:

  • Erythema nodosum (skin disease);
  • Arthritis (joint inflammation);
  • Adenopathy (swollen gaglionilor) at places of entry and exit of the nerves, blood vessels and bronchi in / out of lungs (pulmonary hilum)

     Adenopathy in the lung hilum (the place of entry / exit of the nerves, blood vessels in the lungs) may be evidenced only by an examination of chest radiographs or a computertomography.


Chronic sarcoidosis


     Chronic sarcoidosis begins either asymptomatic or gradually, with fatigue and decreased exercise capacity. Specific organic symptoms may be absent completely. The diagnosis is often put on a chest X-ray. Chronic sarcoidosis prognosis is worse than the acute form. Because symptoms of chronic sarcoidosis rarely occur, the establishment of treatment is done quite late.


Evolution and prognosis of sarcoidosis


     Evolution and prognosis of sarcoidosis are generally favorable. In about 95% of acute form it heals spontaneously without treatment within a period of four to six weeks. Full recovery takes several months. After one year of regress all highlighted radiological lung changes.

     Even the chronic forms of sarcoidosis are usually easily cured by administration of cortisone. If chronic illness is evolving, with attacks of relapse, regular doctor should be consulted. Approximately 5% of the sick people die due to complications in the brain or heart or if there are serious structural changes of lungs.

     Possible complication of sarcoidosis depends on the organ affected and it occurs in the chronic forms of disease such as pulmonary fibrosis, kidney failure, permanent paralysis or vision problems.

     Sarcoidosis can be diagnosed relatively frequently due to ocular manifestations (uveitis, iritic, conjunctivitis), to skin manifestations (erythema nodosum, lupus pernio) or due to neurologic manifestations (cranial nerve palsy, peripheral neuropathy or presence of a brain tumor). Sarcoidosis may be suspected if there exists pituitary dysfunction or increase calcium, in the cases of hepatosplenomegaly, lithic bone lesions or arthritis. This disease is a possible cause of cardiac events, causing driving difficulties, arrhythmias, cardiomyopathy or sudden death. Sarcoidosis should be considered even in the case of unspecified fever (through the extensive involvement of the retroperitoneal lymph).