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Sarcoidosis often leads to the development of abnormal masses in the skin and even inside the body. The management of sarcoidosis requires close monitoring of the symptoms to track the progress of the disease and the effectiveness of the treatments.
Home Remedies and Lifestyle Changes for Sarcoidosis
Most individuals with sarcoidosis experience chronic fatigue. While there are no specific “home remedies” that are effective for sarcoidosis treatment, there are lifestyle efforts that can help, including:
- Regular moderate exercise
- Adequate sleep hygiene
- Maintaining normal body weight
- Following a whole foods diet – Inflammatory foods such as those with added sugars, fried or processed and “junk foods” should be avoided.
- Quitting smoking
- Stress management – This is important to avoid exacerbating sarcoidosis symptoms. Meditation and relaxation therapies can be most helpful.
- Participation in a sarcoidosis support group – This can also help by connecting with other people who struggle with this uncommon condition.
Complications of Untreated Sarcoidosis
Most patients with sarcoidosis do not require treatment, and the condition resolves over time.
Some individuals may have radiographic signs of stage II or III lung disease despite a lack of symptoms and are often advised to accept treatment to prevent further lung damage.
If the condition is left untreated in such patients, worsening lung disease and pulmonary fibrosis may ensure, leading to chronic lung damage. This is also true for “extrapulmonary” disease involvement, which may advance without treatment.
Risk of Stroke in Severe Sarcoidosis
Generally not, but about 5%–10% of patients with sarcoidosis may have central nervous system sarcoidosis, (1) which may lead to a number of neurologic problems, often mimicking a stroke, as granulomas may accumulate in the brain.
Other neurologic symptoms may include seizures, confusion, and peripheral nerve weakness.
Vitamin D Toxicity in Sarcoidosis Patients
Vitamin D metabolism in sarcoidosis is quite complex and poorly understood.
Hypercalcemia and hypercalciuria often occur in sarcoidosis. This is believed to be due to the exaggerated vitamin D activation by the macrophages (inflammatory white blood cells) present in the granulomas.
One of the many activities of vitamin D is to regulate calcium metabolism. Elevated levels of vitamin D result in increased intestinal absorption of calcium and leaching calcium from bone, contributing to osteoporosis.
Under ordinary circumstances, vitamin D toxicity is rare, and people often supplement it without problems. However, in patients with sarcoidosis, additional vitamin D may result in toxicity.
Of note, studies have also shown that low vitamin D levels in patients with sarcoidosis contribute to both disease activity and excessive urinary calcium excretion and osteoporosis. (2) Many experts advise against vitamin D supplementation in patients with sarcoidosis, while also watching carefully to make certain that vitamin D deficiency is not present.
Is Sarcoidosis a Contagious Disease?
No, it is not.
Fatality of Lung Sarcoidosis
Although 90% of those with sarcoidosis have lung involvement, only a small number of patients advance to stage IV disease, which indicates advanced fibrosis of the lung and significant chronic pulmonary insufficiency. (3)
While about 65% of those with lung involvement experience complete remission over a period of 2–5 years, about one-third of patients develop chronic lung disease requiring treatment. (4) The mortality rate of sarcoidosis is about 5%, usually due to advanced lung disease. (5)
Role of Genes in Sarcoidosis Development
There is a slightly increased risk of developing sarcoidosis among first-degree relatives, but the familial clustering of cases is not common.
A number of genes have been associated with an increased risk of developing sarcoidosis, (6) but this is not a strong association. It appears that while there is some genetic component, environmental factors are much more important in disease development.
Conditions That Mimic Sarcoidosis
Many of the lung findings in sarcoidosis, including granulomas in affected tissues, appear quite similar to those seen in tuberculosis. Therefore, it is difficult to distinguish between these conditions even with a biopsy.
However, TB granulomas are caseating, while sarcoidosis granulomas are non-caseating. A skilled pathologist can make this distinction.
Sarcoidosis can mimic a number of other conditions, including:
- Fungal infections
- Lymphoma
- Hodgkin’s disease
- Hepatitis
- Sjogren’s syndrome
- Rheumatoid arthritis
- Vasculitis
So, it is important to consider these conditions and exclude them.
How Are These Conditions Diagnosed?
It is also important to rule out tuberculosis by either culturing sputum or performing a skin (PPD) test or a blood QuantiFERON-TB Gold test. If lymphoma or Hodgkin’s disease is suspected, a tissue biopsy will be required to exclude malignant disease.
Some patients with sarcoidosis have prominent joint pains and swelling, which can look much like rheumatoid arthritis. If salivary and eye involvement is present, Sjogren’s syndrome may be considered.
While it is usually not difficult to distinguish between these conditions, given the substantial clinical overlap of signs and symptoms, it is important to consider all diagnostic possibilities. An experienced physician, usually a rheumatologist or pulmonologist, is required.
Relation Between Lofgren Syndrome and Sarcoidosis
Lofgren syndrome is a particular subset of sarcoidosis that presents with hilar adenopathy on chest X-ray, erythema nodosum often with ankle and knee swelling, and arthritis.
This condition can be quite acute and is associated with systemic symptoms of fatigue and malaise. Fortunately, it resolves in 90% of cases, usually within 2 years, never to return. (7)
Is Sarcoidosis a Chronic Disease?
Although considered a chronic disease, the course of sarcoidosis is variable. Many patients will experience episodes of symptomatic illness requiring treatment, only to improve and become disease-free for long periods. Less commonly, persistent symptomatology requires ongoing medication to control the disease.
Final Word
Sarcoidosis has no cure, but most cases resolve on their own, and patients see their skin clearing up. However, it is vital to detect sarcoidosis in other organs at the earliest, as timely intervention can help prevent severe health problems.
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