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Home > Respiratory Health > Lung Diseases > Sarcoidosis: Lifestyle Changes and Complications

Sarcoidosis: Lifestyle Changes and Complications

July 2, 2020 - Updated on August 2, 2021
6 min read
By David Lans, DO, FACP | Rheumatologist

In this article:

  • Home Remedies and Lifestyle Changes for Sarcoidosis
  • Complications of Untreated Sarcoidosis
  • Risk of Stroke in Severe Sarcoidosis
  • Vitamin D Toxicity in Sarcoidosis Patients
  • Is Sarcoidosis a Contagious Disease?
  • Fatality of Lung Sarcoidosis
  • Role of Genes in Sarcoidosis Development
  • Conditions That Mimic Sarcoidosis
  • How Are These Conditions Diagnosed?
  • Relation Between Lofgren Syndrome and Sarcoidosis
  • Is Sarcoidosis a Chronic Disease?
  • Final Word

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.

lifestyle changes to manage sarcoidosis

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

complications associated with 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.

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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

can excess vitamin D cause toxicity in patients with sarcoidosis?

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.

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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

is sarcoidosis in the lungs fatal?

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.

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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?

how are the 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.

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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.

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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.

Continue Reading Continue ReadingSarcoidosis: Causes, Symptoms, Treatment, and Diagnosis
References
  1. Lacomis D. Neurosarcoidosis. Current neuropharmacology. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3151597/. Published September 2011.
  2. Burke RR, Rybicki BA, Rao DS. Calcium and vitamin D in sarcoidosis: how to assess and manage. Seminars in respiratory and critical care medicine. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4876288/. Published August 2010.
  3. Ungprasert P, Ryu JH, Matteson EL. Clinical Manifestations, Diagnosis, and Treatment of Sarcoidosis. Mayo Clinic proceedings. Innovations, quality & outcomes. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6713839/. Published August 2, 2019.
  4. Al-Kofahi K, Korsten P, Ascoli C, et al. Management of extrapulmonary sarcoidosis: challenges and solutions. Therapeutics and clinical risk management. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5106225/. Published November 7, 2016.
  5. Moor CC, Kahlmann V, Culver DA, Wijsenbeek MS. Comprehensive Care for Patients with Sarcoidosis. Journal of clinical medicine. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7074229/. Published February 1, 2020.
  6. Fischer A, Rybicki BA. Granuloma genes in sarcoidosis: what is new? Current opinion in pulmonary medicine. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4569001/. Published September 2015.
  7. Baughman RP, Culver DA, Judson MA. A concise review of pulmonary sarcoidosis. American journal of respiratory and critical care medicine. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3081278/. Published March 1, 2011.
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