Sarcoidosis is a condition characterized by the presence of granulomas
- small beadlike patches of inflamed cells
- that often appear in the lungs and adjacent lymph
nodes. Sarcoidosis can also affect other tissues of the body including the
muscles, eyes, and skin. While most individuals with sarcoidosis have no
symptoms at all, sarcoidosis can cause long-term organ damage, such as the
abnormal formation of fiber-like scar tissue in the lung. This actually distorts
the structure of the lungs and can interfere with breathing. Those who have a
variation of the condition, called Lofgren's syndrome, may have symptoms that
include swollen lymph nodes, fever, painful, reddened nodules, and joint pain.
Lofgren's syndrome is found more frequently in persons of Scandinavian, Irish,
and Puerto Rican descent and it generally tends to clear up on its own within
one to two years. The prevalence of sarcoidosis is higher in Blacks than Whites
in the United States; about 36 in 100,000 Black Americans and 11 in 100,000
White Americans have the condition.
Signs and Symptoms
Many individuals with sarcoidosis have no symptoms at all.
Some individuals with pulmonary (lung) sarcoidosis may experience the
following signs and symptoms:
Fatigue and weakness
Weight loss
Shortness of breath or chest pain
Dry cough
Enlarged lymph nodes around the lungs
When sarcoidosis affects areas of the body other than the lungs, symptoms can
include:
Enlarged lymph nodes
Red-purple inflamed areas on the legs
Scaly rash
Fever
Swelling and pain in the ankles and knees
Infections of the eye, including conjunctivitis
Facial paralysis
Enlarged or inflamed liver
Kidney stones
Seizures
Causes
Although the precise cause of sarcoidosis is unknown, some scientists
speculate that an exaggerated defense reaction against some event or substance
perceived as a threat by the immune system may trigger the condition. Other
researchers have proposed that the condition may be inherited, caused by an
infection, or caused by inhaled allergens or toxins found in the environment.
The National Heart, Lung, and Blood Institute is currently conducting a study to
determine the cause of the condition.
Risk Factors
Sarcoidosis is found throughout the world within almost all races and ages
and in both sexes, however it is most common among the
following:
Individuals of Scandinavian, Irish, African, or Puerto Rican descent
Individuals in their 30s or 40s
Females
Diagnosis
Although many individuals with sarcoidosis experience no symptoms of the
condition, the following tests may help a physician diagnose the
condition:
Chest X ray
Biopsy
Blood tests
CT scan, MRI, or other imaging tests
Eye exam
EKG (electrocardiogram)
Treatment Approach
About half of all individuals with sarcoidosis recover spontaneously and do
not need treatment. For those who do not recover spontaneously, symptom relief
and prevention of complications are often provided by medications such as
corticosteroids, which reduce swelling, rashes, pain, fever and lung problems.
Some
lifestyle changes, including a diet low
in calcium or avoidance of vitamin D and sunlight, may help control some of the
complications of the condition, such as kidney stones or other damage. While
complementary therapies for sarcoidosis have not been well studied, anecdotal
reports suggest that melatonin and homeopathy may provide symptom
relief and improve general well-being.
Lifestyle
Eating a diet low in calcium and vitamin D may relieve or help prevent two of
the complications of sarcoidosis, hypercalcemia (an abormally high amount of
calicium in the blood) and kidney disease. A physician can provide advice on how
to cut calcium out of the diet.
Avoiding sunlight, which is converted to vitamin D by the body, is also
recommended.
Quitting smoking can ease lung symptoms.
Medications
Corticosteroids such as prednisone, prescribed by a physician, are the most
effective medications for reducing inflammation associated with sarcoidosis.
Oral corticosteroids can have some serious side effects if taken in high doses
for long periods, including high blood pressure, diabetes, peptic ulcers,
tuberculosis, or hirsutism (excessive hair growth). If an individual is at risk
for these problems, a physician will likely advise regular check-ups and
tests.
Other medications for sarcoidosis can include:
Methotrexate - for severe sarcoidosis; may
cause liver damage
Antimalarial drugs such as hydroxychloroquine
- for disfiguration of the skin; may be toxic to the
eyes
Surgery and Other Procedures
Surgery, such as a lung or heart transplant, is only necessary in extreme
cases.
Nutrition and Dietary Supplements
Melatonin: For individuals with chronic sarcoidosis who do not respond
to corticosteroids, preliminary studies suggest that the brain hormone melatonin
may be an effective alternative. In one study, individuals with sarcoidosis who
did not respond to corticosteroid therapy experienced the following improvements
after taking 20 mg of melatonin per day for 4 to 12 months:
Improved breathing
Decreased lymph node swelling
Normalization of blood tests (indicate improvement in the
condition)
Once the melatonin supplements were discontinued, however, these improvements
disappeared. More extensive research will help better determine the value of
using this supplement for sarcoidosis.
Homeopathy
A few case reports suggest that homeopathic remedies may improve the general
well-being of individuals with sarcoidosis. An experienced homeopath can
prescribe a regimen for treating sarcoidosis that is designed specifically for
each individual. The primary remedies used by individuals who reported
improvements in their symptoms include:
Tuberculinum bovinum
Beryllium
Other homeopathic remedies that have been used clinically for the condition
are as follows:
Carcinosin
Euphrasia
Graphites
Leuticum (Syphilinum)
Bacillinum
Sepia
Phosphorus
Arsenicum
album
Other Considerations
Pregnancy
Sarcoidosis does not affect fertility. Symptoms may improve in up to 65% of
pregnant women who once had the condition, while 5% may experience worsening of
symptoms. Postpartum symptom flare-ups may also occur within the first 6 months.
Pregnant women with sarcoidosis should avoid exposure to X rays and toxic
medications such as methotrexate.
Prognosis and Complications
Complications from sarcoidosis usually occur in only the most serious cases,
and can include heart, kidney, and lung damage. Ulcers, diabetes, high blood
pressure, and infections, such as tuberculosis, may result from long-term use of
corticosteroids.
The prognosis for most individuals with sarcoidosis is good. Only 15% of
those with sarcoidosis experience symptoms that progressively worsen and 5%
develop severe lung problems, which increases the risk of death. Almost half of
all individuals with sarcoidosis spontaneously improve without any therapy, and
treatments used today, such as coritcosteroids, are often successful in helping
to ease the inflammation associated with the
condition.
Supporting Research
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allopurinol. Br J Dermatol. 2000;142(5):1052-1053.
Cagnoni ML, Lombardi A, Cerinic MC, Dedola GL, Pignone A. Melatonin for
treatment of chronic refractory sarcoidosis [letter]. Lancet.
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Il 'kovich MM, Novikova LN, Baranova OP. Weight-reducing diet therapy in the
combined treatment of pulmonary sarcoidosis [in Russian]. Ter Arkh.
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Koopman WJ, ed. Arthritis and Allied Conditions, 13th ed. Baltimore,
MD: Williams & Wilkins, Inc.; 1997.
Newman LS, Rose CS, Maier LA. Sarcoidosis. N Engl J Med.
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Paramothayan NS, Jones PW. Corticosteroids for pulmonary sarcoidosis.
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Rakel RE, ed. Conn's Current Therapy, 51st ed. Philadelphia, Pa: W.B.
Saunders; 1999.
Tani K, Ogushi F, Huang L, et al. CD13/aminopepetidase N, a novel
chemoattractant for T lymphocytes in pulmonary sarcoidosis. Am J Respir Crit
Care Med. 2000;161(5):1636-1642.
Waldinger TP, Ellis CN, Quint K, Voorhees JJ. Treatment of cutaneous
sarcoidosis with isotretinoin. Arch Dermatol. 1983;119(12):1003-1005.
Weinberg I, Vasiliev L, Gotsman I. Anti-dsDNA antibodies in sarcoidosis.
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Review Date: March 2001
Reviewed By: Participants in the review process include: Constance Grauds, RPh, President,
Association of Natural Medicine Pharmacists, San Rafael, CA; Jacqueline A. Hart,
MD, Department of Internal Medicine, Newton-Wellesley Hospital, Harvard
University and Senior Medical Editor Integrative Medicine, Boston, MA; Lonnie
Lee, MD, Internal Medicine, Silver Springs, MD; Leonard Wisneski, MD, FACP,
George Washington University, Rockville,
MD.
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