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Sarcoidosis is a disease characterized by the development and growth of tiny clumps of inflammatory cells in different areas of your body. Sarcoidosis can affect virtually any organ, but most commonly it affects your lungs, lymph nodes, eyes and skin. Doctors believe sarcoidosis results from an abnormal immune response. The course of the disease varies from person to person. It often goes away on its own, but in some people symptoms of sarcoidosis may last a lifetime. If you have minor symptoms of sarcoidosis, you may only need to be monitored until the condition improves. But if symptoms bother you or put vital organs at risk, treatment with anti-inflammatory medications can help.
Complications of Sarcoidosis
In about two-thirds of people with sarcoidosis, the condition resolves with no lasting consequences. But in some people, sarcoidosis can become chronic and lead to complications, including:
In a few cases, sarcoidosis can be fatal. Death usually occurs as a result of progressive scarring of the lungs and respiratory failure, or as the result of a heart problem, which may lead to sudden death.
Causes of Sarcoidosis
Signs & Symptoms of Sarcoidosis
Signs and symptoms of sarcoidosis tend to vary, depending on which organs are affected and how long you've had the disease. Some cases cause few, if any, symptoms, and as a result the disease may not be discovered until you have a chest X-ray for other reasons.
In general, sarcoidosis symptoms include:
Sometimes sarcoidosis develops gradually and produces signs and symptoms that last for years. Or it may appear suddenly and then disappear just as quickly.
Diagnosis of Sarcoidosis
Few symptoms early on
Sarcoidosis produces few signs and symptoms in its early stages. In some cases, sarcoidosis is diagnosed incidentally based on an X-ray that was taken for other reasons.
When signs and symptoms do occur, they often resemble those of other illnesses. For that reason, your doctor will diagnose sarcoidosis only after ruling out diseases with similar features, such as lymphoma, tuberculosis, rheumatoid arthritis, rheumatic fever and fungal infections.
Even then, doctors can miss sarcoidosis. In the majority of cases, undiagnosed sarcoidosis disappears spontaneously, but a few people go on to develop more-severe signs and symptoms — usually over a period of years.
Commonly used tests
Your doctor will likely use a number of tests to help determine if you have sarcoidosis, how severe it may be and the extent of your treatment. Tests may include:
You may hear your doctor talk about the stage of the disease in your lungs. Staging is usually based on the results of your chest X-rays.
All stages require close follow-up, even if not treated at the time. You can have involvement of your liver, skin, heart, eyes or other organs at any stage, even Stage 0.
Treatments of Sarcoidosis
You may not need treatment for sarcoidosis if you don't have any signs and symptoms or if they aren't bothering you. Because sarcoidosis often disappears on its own at this stage, your doctor is likely just to monitor you closely.
When chest X-rays reveal more widespread areas of lung inflammation, your doctor may monitor the disease for three to 12 months and begin treatment if the inflammation hasn't improved or has progressed.
On the other hand, treatment with medications is usually recommended if your heart, eyes, kidneys or central nervous system is involved, as related complications can be serious.
Doctors generally use the corticosteroid drug prednisone to treat sarcoidosis. Corticosteroids are powerful anti-inflammatory drugs that mimic the effects of hormones produced by your adrenal glands. They're not the same as the anabolic steroids used by some athletes to increase strength and muscle mass.
Just how long to continue prednisone is a matter of debate. In some cases, you may take medication for several years, using as low a dose as possible while still controlling the disease. For a small percentage of people, symptoms return when the medication is discontinued. In addition, prednisone can cause serious side effects, especially when it's taken long term. These side effects include:
Talk to your doctor about the best ways to help prevent or reduce the possibility of side effects. One option is to take prednisone every other day, rather than every day.
If you aren't able to tolerate steroid treatment, your doctor may recommend treatment with drugs that help reduce inflammation by suppressing your immune system. Options may include methotrexate or azathioprine (Imuran). But these drugs are powerful, as well, and carry their own risks, such as making you more vulnerable to infections.
The antimalarial drug, hydroxychloroquine (Plaquenil), may be helpful for skin disease, nervous system involvement and elevated blood-calcium levels.
Your doctor can help you decide on the best sarcoidosis treatment. This usually involves weighing the risks and benefits of medications such as corticosteroids and immunosuppressants against the discomfort and risks of leaving the disease untreated.
When to seek Medical Advice
You may not realize you have sarcoidosis, especially early in the course of the illness. But if you're tired, have a fever, have lost weight, have shortness of breath and a cough that persists for weeks or months, or have raised skin eruptions and joint pain (arthralgia), see your doctor — these signs and symptoms may indicate sarcoidosis.
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