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Sarcoidosis


Signs and Symptoms
Causes
Risk Factors
Diagnosis
 
Treatment
Other Considerations
Supporting Research

Sarcoidosis is a condition where small bead-like patches of inflamed cells -- called granulomas -- show up in the body, usually in the lungs and nearby lymph nodes. Sarcoidosis can also affect other parts of the body, including the muscles, eyes, and skin.

Many people with sarcoidosis may have no symptoms at all. But in others, the condition can cause long-term organ damage. An example is the formation of fiber-like scar tissue in the lung, which can cause breathing problems. Sarcoidosis may develop over time and cause symptoms that last for years, or it may show up and go away quickly.

People who have a variation of sarcoidosis, called Lofgren's syndrome, may have symptoms that include swollen lymph nodes, fever, painful, reddened nodules, and joint pain. Lofgren's syndrome generally tends to clear up on its own within 1 - 2 years.

Sarcoidosis affects more African-Americans than Caucasians in the United States. About 36 in 100,000 African-Americans, while 11 in 100,000 Caucasians have the condition.

Signs and Symptoms

Many people with sarcoidosis have no symptoms at all.

Some people with pulmonary (lung) sarcoidosis may have the following signs and symptoms:

  • Shortness of breath
  • Fatigue and weakness
  • Weight loss
  • 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 bumps on arms, face, buttocks
  • Fever
  • Swelling and pain in the ankles and knees
  • Infections of the eye, including pink eye (conjunctivitis)
  • Enlarged or inflamed
  • Enlarged or inflamed liver

Causes

Researchers don't know exactly what causes sarcoidosis. Some think it's due to an overactive immune system that responds too strongly to an invading organism. Other researchers have proposed that sarcoidosis may be inherited, caused by an infection, or caused by allergens that are breathed in or toxins found in the environment.

Risk Factors

Anyone can develop sarcoidosis, although it's more common among the following:

  • People of Scandinavian, Irish, African, or Puerto Rican descent
  • People in their 30s or 40s
  • Women

Diagnosis

Sarcoidosis can be hard to diagnose. You may have to see several different doctors, including a pulmonologist (lung specialist). To begin, your doctor will rule out other conditions that could be causing your symptoms, such as rheumatoid arthritis. The following tests may help diagnose the condition:

  • Chest x-ray
  • Lung function tests
  • Biopsy
  • Blood tests
  • Bronchoscopy -- examines the inside of your lungs
  • CT scan, MRI, or other imaging tests
  • ECG (electrocardiogram)

Treatment

About half of all people with sarcoidosis get better without needing treatment. For others, medications such as corticosteroids may help reduce swelling, rashes, pain, fever, and lung problems. Some lifestyle changes may help control complications, such as kidney stones or other damage. While complementary therapies for sarcoidosis have not been well studied, they may help you feel better as part of an overall treatment plan.

Lifestyle

If you smoke, quit. Quitting smoking can ease lung symptoms.

Sarcoidosis can be a long-lasting disease, so it's important to eat a healthy diet filled with fruits, vegetables, and whole grains.

Exercise regularly. Be sure to ask your doctor before starting a new exercise program, especially if sarcoidosis leaves you short of breath.

Medications

Corticosteroids such as prednisone are considered the first-line treatment for lowering inflammation associated with sarcoidosis. Oral corticosteroids can have some serious side effects if taken in high doses for long periods. Side effects may include high blood pressure, diabetes, peptic ulcers, tuberculosis, or osteoporosis. Your doctor will likely suggest regular check-ups and tests.

Other medications sometimes used for sarcoidosis include those that suppress the immune system, such as methotrexate, azathioprine (Imuran), and infliximab (Remicade). However, there are no long-term studies on whether these medication are effective for treating sarcoidosis.

Other medications that may be used include:

Antimalarial drugs such as hydroxychloroquine -- used when the skin is affected. It may be toxic to the eyes.

Thalidomide -- being studied for sarcoidosis; used to improve lung function and treat skin problems.

Surgery and Other Procedures

Surgery, such as a lung or heart transplant, is only necessary in very severe cases.

Nutrition and Dietary Supplements

Although there is no evidence that any particular herb or supplement helps treat sarcoidosis, a comprehensive treatment plan may include complementary and alternative therapies. Ask your team of doctors about the best ways to bring these therapies into your overall treatment plan. Always tell your doctor about the herbs and supplements you are using or considering using, as some supplements may interfere with conventional treatments.

These nutritional tips will help your overall health:

  • Eat antioxidant foods, including fruits (such as blueberries, cherries, and tomatoes), and vegetables (such as squash and bell peppers).
  • Include foods rich in magnesium and low in calcium, such as barley, bran, corn, rye, oats, soy, brown rice, avocado, banana, and potato.
  • Avoid refined foods, such as white breads, pastas, and sugar.
  • Eat fewer red meats and more lean meats, cold-water fish, tofu (soy, if no allergy) or beans for protein.
  • Use healthy oils, such as olive oil or vegetable oil.
  • Reduce or eliminate trans-fatty acids, found in commercially baked goods such as cookies, crackers, cakes, French fries, onion rings, donuts, processed foods, and margarine.
  • Avoid caffeine, alcohol, and tobacco.
  • Drink 6 - 8 glasses of filtered water daily.
  • Exercise at least 30 minutes daily, five days a week. Ask your doctor before starting a new exercise routine.

The following supplements may also help overall health:

  • A daily multivitamin, containing the antioxidant vitamins A, C, E, the B-complex vitamins, and trace minerals such as magnesium, calcium, zinc, and selenium.
  • Omega-3 fatty acids, such as fish oil, 1 - 2 capsules or 1 - 3 tablespoonfuls oil, one to three times daily. Fish oil seems to help reduce inflammation throughout the body. Cold-water fish, such as salmon or halibut, are good sources to add to your diet. If you take supplements, check with your doctor because they may increase the risk of bleeding, especially if you take blood thinners such as warfarin (Coumadin) or aspirin. Eating fish doesn’t cause the same risk.
  • Bromelain, a mixture of enzymes derived from pineapple, 500 mg per day. Bromelain may also help reduce inflammation in the body. Ask your doctor before taking it, because it can increase the risk of bleeding and may interact with other medications.
  • Probiotic supplement (containing Lactobacillus acidophilus), 5 - 10 billion CFUs (colony forming units) a day. These "friendly" bacteria help maintain gastrointestinal health. You should refrigerate your probiotic supplements for best results.

Herbs

Herbs are generally a safe way to strengthen and tone the body's systems. As with any therapy, you should work with your health care provider to get your problem diagnosed before starting any treatment. You may use herbs as dried extracts (capsules, powders, teas), glycerites (glycerine extracts), or tinctures (alcohol extracts). Unless otherwise indicated, you should make teas with 1 tsp. herb per cup of hot water. Steep covered 5 - 10 minutes for leaf or flowers, and 10 - 20 minutes for roots. Drink 2 - 4 cups per day. You may use tinctures alone or in combination as noted.

Studies haven’t found any herbs that specifically treat sarcoidosis. However, the following herbs may help overall health. Talk to your doctor before taking any herb or supplement if you have sarcoidosis.

  • Turmeric (Curcuma longa) standardized extract, 300 mg three times a day, may help reduce inflammation. Turmeric may increase the risk of bleeding and interact with other medications, so ask your doctor before taking it.
  • Cat's claw (Uncaria tomentosa) standardized extract, 20 mg three times a day, may help reduce inflammation. People with leukemia should not take cat’s claw. Cat’s claw interacts with some medications, so ask your doctor before taking it.

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

Women with sarcoidosis can still get pregnant. But if you are thinking about having a baby, talk to your doctor. Some of the medications used to treat sarcoidosis, such as methotrexate, can be harmful to the baby. Up to 65% of women may see their symptoms improve during pregnancy, while 5% may find symptoms get worse. Some women may have a flare of symptoms after giving birth. Pregnant women with sarcoidosis should avoid being exposed to x-rays.

Prognosis and Complications

Complications from sarcoidosis usually happen in only the most serious cases, and can include heart, kidney, and lung damage. Long-term use of corticosteroids may cause ulcers, diabetes, high blood pressure, osteoporosis, and infections, such as tuberculosis.

The prognosis for most people with sarcoidosis is good. Only 15% of those with sarcoidosis have symptoms that get worse. About 5% develop severe lung problems, which increases the risk of death. Almost half of all people with sarcoidosis get better without any therapy. Treatments used today, such as corticosteroids, often help ease the inflammation associated with the condition.

Supporting Research

Boots AW, Drent M, Swennen EL, Moonen HJ, Bast A, Haenen GR. Antioxidant status associated with inflammation in sarcoidosis: A potential role for antioxidants. Respir Med. 2009 Mar;103(3):364-72.

Cox CE, Donohue JF, Brown CD, Kataria YP, Judson MA. Health-related quality of life of persons with sarcoidosis. Chest. 2004 Mar;125(3):997-1004.

Dambro MR. Griffith's 5-Minute Clinical Consult. Baltimore, Md: Lippincott Williams & Wilkins, Inc.; 2006.

Doty JD, Mazur JE, Judson MA. Treatment of sarcoidosis with infliximab. Chest. 2005 Mar;127(3):1064-71.

Dryden GW Jr, Deaciuc I, Arteel G, McClain CJ. Clinical implications of oxidative stress and antioxidant therapy. Curr Gastroenterol Rep. 2005;7(4):308-16.

Fauci AS, Braunwald E, Hauser SL, et al, eds. Harrison's Principles of Internal Medicine. 17th ed. New York, NY: McGraw-Hill; 2008.

Funk JL, Oyarzo JN, Frye JB, et al. Turmeric extracts containing curcuminoids prevent experimental rheumatoid arthritis. J Nat Prod. 2006;69(3):351-5.

Goldman L, Ausiello DA, et al, eds. Cecil Textbook of Medicine. 23rd ed. Philadelphia, Pa: W.B. Saunders; 2007.

Gonclaves C, Dinis T, Batista MT. Antioxidant properties of proanthocyanidins of Uncaria tomentosa bark decoction: a mechanism for anti-inflammatory activity. Phytochemistry. 2005;66(1):89-98.

Goroll AH, ed. Primary Care Medicine, 5th ed. Philadelphia, Pa: Lippincott Williams & Wilkins Publishers; 2007.

Krieg C. Role of diet in the prevention of common kidney stones. Urol Nurs. 2005;25(6):451-7.

Lichtenstein AH, Russell RM. Essential nutrients: food or supplements? Where should the emphasis be? JAMA. 2005;294(3):351-8.

Massey L. Magnesium therapy for nephrolithiasis. Magnes Res. 2005;18(2):123-6.

Nguyen YT, Dupuy A, Cordoliani F, Vignon-Pennamen MD, Lebbé C, Morel P, Rybojad M. Treatment of cutaneous sarcoidosis with thalidomide. J Am Acad Dermatol. 2004 Feb;50(2):235-41.

Rakel RE, ed. Conn's Current Therapy 2008. Philadelphia, Pa: W.B. Saunders; 2008.


Review Date: 9/3/2010
Reviewed By: Steven D. Ehrlich, NMD, Solutions Acupuncture, a private practice specializing in complementary and alternative medicine, Phoenix, AZ. Review provided by VeriMed Healthcare Network.
The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. © 1997- A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.
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