The signs and therapeutic options of sarcoidosis

Sarcoidosis is a complex, benign disease that can cause various lesions in the tissues of the body. The condition often remains hidden and is frequently discovered accidentally, for example, during imaging examinations. Sarcoidosis can develop in a variety of ways, and the chances of recovery also differ. Although the disease often resolves spontaneously in many cases, more severe forms can lead to organ failures, which can even result in death.

This disease process is particularly difficult to predict, making it challenging to develop treatment strategies. The diagnosis can often come as a surprise to patients, as approximately 30% of diagnosed cases require treatment. Sarcoidosis most commonly occurs in young adults, with the highest incidence observed in Scandinavia.

The disease primarily manifests in the lungs but can also affect other organs, such as the lymph nodes, skin, and eyes. The lesions caused by sarcoidosis, known as granulomas, develop as part of the body’s immune response. These tissue changes are similar to those seen in fungal infections and play an important role in inflammatory processes.

The Symptoms of Sarcoidosis

The diagnosis of sarcoidosis often occurs during a discovery when characteristic lesions are found on the patients’ X-ray images. About 25% of patients may experience general symptoms, which include fatigue, fever, blurred vision, light sensitivity, and shortness of breath. In more severe cases, the disease may also be associated with spleen or liver enlargement, necessitating further examinations for the patients.

Granulomas most commonly form in the left ventricle of the heart, which can lead to various heart problems. Additionally, kidney stones may appear, but kidney failure is rare. Skin lesions, especially on the face and nose, occur in about one-third of patients, and although they are not life-threatening, they can cause emotional distress.

The disease can also cause eye symptoms, including enlargement of the tear glands, peripheral facial nerve paralysis, and hearing loss. The central nervous system may also be affected, with common symptoms including headaches and weakness.

There are two main forms of sarcoidosis: acute and chronic. The acute form causes sudden symptoms, often accompanied by bilateral lymphadenopathy. The chronic form may remain asymptomatic for a long time and is characterized by gradually developing lesions in lung tissue. The stages of the disease are classified based on radiological features, depending on the condition of the lungs.

The Diagnosis and Causes of Sarcoidosis

The diagnosis of sarcoidosis is often based on the typical lesions visible on a chest X-ray, but this alone is not sufficient. A biopsy is needed to confirm the disease, typically performed surgically.

Additional confirmation of the diagnosis may involve measuring blood calcium levels, conducting pulmonary function tests, as well as performing EKG and ophthalmological examinations to rule out involvement of other organs. The causes of sarcoidosis are still not fully understood, but it is believed that the disease may be a consequence of an excessive immune response to an unknown trigger.

Environmental factors, such as irritants in the airways, may also play a role in the development of the disease. Research has observed that certain occupations, such as firefighters and metalworkers, have a higher incidence of sarcoidosis, suggesting a link to high humidity and environmental effects.

Moreover, familial clustering has been observed, particularly in identical twins, indicating a genetic predisposition. If sarcoidosis has occurred in a family, the likelihood of developing the disease can increase fivefold.

The Treatment of Sarcoidosis

Before starting treatment for sarcoidosis, it is often advisable to wait six months, especially for asymptomatic patients, as the disease may regress spontaneously. In stage I, spontaneous recovery is common, but if the disease recurs or severe symptoms arise, medication treatment must be initiated.

Pharmacotherapy generally lasts at least one year, and the standard treatment involves administering 20-40 mg of steroids daily, which can be reduced depending on improvement. If the patient’s condition does not improve or fibrosis develops, alternative medications such as methotrexate may be considered. However, long-term use of steroids requires monitoring for side effects such as osteoporosis, hypertension, and the development of diabetes.

In cases of end-stage fibrosis, treatment can only be achieved through lung transplantation, but the proportion of individuals with sarcoidosis among all lung transplant cases is low. The success of treatment largely depends on the stage of the disease and the individual patient’s response to therapy.