A Clinical Presentation: Sarcoidosis Jeianti Amin UCF NP Resident

What is Sarcoidosis?  It’s an inflammatory disease, where an individual’s immune system overreacts, forming granulomas (microscopic clumps/clusters of inflammatory cells) affecting almost any organ in the body.  Affects people of all ages. In the U.S. it affects African American more than Caucasian, however can affect people of Northern European decent (especially Scandinavian).  Higher rates among women rather than men. Most common in adults age

People at Risk  People who have certain jobs also may be at higher risk for Sarcoidosis. –Health care workers –Elementary and secondary school teachers –People whose jobs expose them to agricultural dust, insecticides, pesticides, or mold –Suppliers of building materials, hardware, or gardening materials –Firefighters –People who have a family history

Sarcoidosis Continues….  Cause is unknown (scientists believes there is a genetic component and some chemical/virus that triggers the immune response, not yet proven).  Not contagious.  Commonly effects the lungs, lymph nodes, skin, eyes and liver. Other organs includes kidneys, heart, brain, nervous system, salivary glands, sinus, muscle and bones (can be multi-system).

Sarcoidosis Symptoms Continue…  Signs & symptoms depends on the organs/body part effected. Many people have no or mild symptoms, less than ½ population effected needs treatment (varies on organs involvement).  Non-specific symptoms includes weight loss, night sweats, and malaise.  When first diagnosed may develop Lofgren’s syndrome: fever, enlarged lymph nodes, arthritis, erythema nodosum (a rash of red or reddish-purple bumps on ankles).

Sarcoidosis Symptoms Continue…  Lungs: 90% affected, experience cough, wheeze, SOB, or chest pain and breathing problems.  Lymph Nodes: 90% affected, enlarged nodes including the spleen.  Liver: 50-80% affected, enlarged liver with abnormal liver enzymes, rarely lead to cirrhosis  Skin: 25% affected, painful or red, raised bumps on the legs or arms (called erythema nodosum), discoloration of the nose, cheeks, lips and ears (called lupus pernio) or small brownish and painless skin patches.

Sarcoidosis Symptoms Continue…  Eyes: 25% affected, common s/s includes burning, itching, tearing, pain, red eye, sensitivity to light (photophobia), dryness, seeing black spots (called floaters) and blurred vision. Chronic uveitis (inflammation of the membranes or uvea of the eye) can lead to glaucoma, cataracts and blindness.  Heart: 10-25% affected, causing the heart to beat weakly resulting in shortness of breath and swelling in the legs and palpitations.  Brain & Nervous System: 5-13% affected, experiencing headaches, visual problems, weakness or numbness of an arm or leg and facial palsy, poor coordination, seizures, tremors, problems walking.

Sarcoidosis Continue…  Musculosketal: 33% affected with arthritis all joints, muscle weakness  Sinus: 5% affected, symptoms include sinusitis, hoarseness, SOB.  Other Organs: Rarely, the gastrointestinal tract, reproductive organs, salivary glands and the kidneys (kidney stones) are affected.  Diagnostic Tests: –Physical Exam –Chest X-ray –Blood Test (ACE level) –Pulmonary Function Test –EKG, Holter monitor –CT/MRI/PET –Bronchoscopy Biopsy

Treatment  Treatment is geared towards severity or symptoms (usually treat with lung, kidney, heart, brain, nervous system, eyes involvement).  Treatment plans depends on how well patient respond to medicine and severity.  No cure. Rarely fetal.  Death results from complications with lungs, heart, brain.  Follow healthy lifestyle (eat healthy, exercise, quit smoking).  Seek ongoing medical care for pregnancy, emotional stress (fear, anxiety, depression and support groups).  Treatment geared: –Reduce inflammation –Reduce size of granulomas – Prevent permanent scarring of the lungs and other organs –Decrease symptoms usually with corticosteroids (prednisone), NSAIDS, Hydroxychloroquine (treat skin, brain and high level of calcium resulting from Sarcoidosis) and Methotrexate (treating Sarcoidosis that affects your lungs, eyes, skin, or joints).

References  Foundation for Sarcoidosis Research, What is sarcoidosis. Retrieved October 01, 2010 from s/diseasefacts.htm s/diseasefacts.htm s/diseasefacts.htm  National Heart, Lung, Blood Institute, Sarcoidosis. Retrieved October 01, 2010 from ses/sarc/sar_whatis.html ses/sarc/sar_whatis.html ses/sarc/sar_whatis.html

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