Sarcoidosis

Sarcoidosis is a multisystem inflammatory disease characterized by noncaseating granulomas. It most commonly affects lungs and intrathoracic lymph nodes but can involve skin, eyes, heart, liver, and nervous system. Some cases resolve spontaneously; others require long-term immunosuppression.

Symptoms

• Persistent dry cough, dyspnea, chest pain
• Fatigue, fever, weight loss, night sweats
• Skin lesions: erythema nodosum, lupus pernio
• Eye inflammation (uveitis, conjunctival lesions)
• Parotid gland swelling, facial nerve palsy
• Arthralgia, sarcoid arthritis
• Cardiac arrhythmias, heart block
• Neurologic deficits (neurosarcoidosis)

Diagnosis

• Clinical + radiographic features (bilateral hilar lymphadenopathy, parenchymal infiltrates)
• Biopsy demonstrating noncaseating granulomas (exclude infection/malignancy)
• Labs: ACE level, soluble IL-2 receptor, calcium, vitamin D metabolism, liver/kidney tests
• Pulmonary function tests (restrictive pattern), DLCO
• Imaging: chest X-ray (Scadding stages I–IV), HRCT, PET for active disease
• Organ-specific assessments: ophthalmologic exam, ECG/echo, cardiac MRI, neurologic evaluation

Treatment & Management

• Many asymptomatic stage I cases can be observed
• First-line: oral corticosteroids (prednisone 20–40 mg/day); taper over 6–12 months
• Steroid-sparing agents: methotrexate, azathioprine, leflunomide, mycophenolate mofetil
• Biologics: infliximab or adalimumab for refractory pulmonary, cutaneous, neurosarcoidosis
• Organ-specific care: pacemakers for heart block, anti-arrhythmics, topical ocular steroids, dermatologic therapy

Lifestyle & Monitoring

• Avoid smoking, minimize dust exposure
• Calcium/Vitamin D monitoring (hypercalcemia risk)
• Regular PFTs, imaging, and lab work to gauge activity
• Exercise and pulmonary rehab to maintain endurance
• Mental health support for chronic fatigue/depression

Complications

• Pulmonary fibrosis and respiratory failure
• Cardiac involvement leading to arrhythmias or sudden death
• Neurosarcoidosis causing cranial neuropathies or spinal cord disease
• Hypercalcemia/nephrolithiasis
• Chronic ocular inflammation leading to vision loss

Research & Future Directions

Areas include biomarkers predicting progression, antifibrotic therapy, and targeted immune modulation.

Experimental & Emerging Treatments

• JAK Inhibitors (tofacitinib, ruxolitinib): Case reports show efficacy in refractory cutaneous and pulmonary sarcoidosis.
• Rituximab & BTK Inhibitors: Target B-cell involvement in resistant cases.
• Anti-TNF + Antifibrotic Combination: Trials explore pairing biologics with nintedanib for advanced pulmonary disease.
• Microbiome & Antigen Discovery: Identifying triggers may allow antigen-specific tolerance therapies.

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Medical Disclaimer: Informational only. Follow your pulmonologist/rheumatologist/ophthalmologist for organ-specific monitoring and immunosuppressive therapy decisions. Sources: American Thoracic Society, European Respiratory Society, Foundation for Sarcoidosis Research