Sarcoidosis - Part II

Last week, we talked about sarcoidosis which is an inflammatory disease that can affect any organ in the body.  Let's continue our discussion today focusing on diagnosis, treatment, and possible complications.

How is the diagnosis of sarcoidosis made?

Diagnosing sarcoidosis can be difficult.  The disease often causes few or vague symptoms in early stages and the symptoms often mimic those of other diseases.  Your doctor will need to do a thorough physical examination to check all the areas that might be affected by sarcoidosis.

Your doctor will also usually recommend some tests to help make the diagnosis and to determine what body systems are involved and the extent or severity of involvement.  These tests include:

• Blood and urine tests
• Chest X-ray
• CT scan of your chest
• Pulmonary (lung) function tests
• Electrocardiogram
• Eye exam
• Biopsies - Usually from the lung, lymph node, or skin.
• MRI or PET scan - especially if there is suspicion of heart or central nervous system involvement

What are the possible complications of sarcoidosis?

Sarcoidosis often goes away without causing any complications, or responds well to treatment, but long-term problems can happen.  These complications can sometimes be life-threatening.  They include:

• Lungs - Permanent scarring with fibrosis in the lungs can make it difficult to breathe and can sometimes cause high blood pressure in the arteries within the lungs.
• Heart - Granulomas in the heart muscle can disrupt the electrical system of the heart, causing abnormal rhythms. They can also impair blood flow and normal heart function, which can cause congestive heart failure and even lead to death.
• Eyes - Inflammation within the eye can eventually cause blindness if not treated.
• Nervous system - Granulomas that form in the brain, nerves, or spinal cord can cause a variety of neurologic symptoms, the most common is facial paralysis on one side.
• Kidneys - Kidney stones, reduced kidney function, and rarely kidney failure can occur.

How is sarcoidosis treated?

Sarcoidosis cannot be cured, but it can be treated.  In many cases, it goes away completely without treatment.  Mild cases may not be treated at all.  If you have severe symptoms or extensive involvement, then treatment may include:

• Corticosteroids - These are powerful anti-inflammatory drugs that are usually the first line treatment for sarcoidosis. They may be taken by mouth, put on the skin in a cream, or put into the eye in drops. 
• Immune suppressants - Act to reduce inflammation.
• Hydroxychloroquine - Can help with skin lesions and elevated blood calcium levels.
• Certain other rheumatoid arthritis medications - Are sometimes used to treat sarcoidosis that has not responded to other treatment.

Ongoing monitoring by your doctor is very important in sarcoidosis, to determine if treatment is needed and monitor for treatment response and complications.

In rare cases, organ transplant may be considered if sarcoidosis has caused severe organ damage that cannot be treated with medication.

For more information about sarcoidosis, use this link:

Sarcoidosis - What Is Sarcoidosis? | NHLBI, NIH

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Dr. Anita Bennett MD - Health Tip Content Editor