Sarcoidosis by Ray Sahelian, M.D.

Sarcoidosis is a systemic granulomatous disease of unknown cause characterized by the formation of noncaseating granulomas. Sarcoidosis primarily involves inflammation that produces tiny lumps of cells in various organs. The lumps are called granulomas because they look like grains of sugar or sand. They are very small and can be seen only with a microscope. These tiny granulomas, over time, enlarge and join each other. If many granulomas form in an organ, they can affect how the organ works. This leads to the symptoms and diagnosis of sarcoidosis. Any organ can be affected, but most often sarcoidosis affects the lungs and lymph nodes.
   Sarcoidosis is thought by most scientists to be a disorder of the immune system, where the body's natural defense system malfunctions.

Cause of sarcoidosis
Sarcoidosis may be linked to seasonal, environmental and genetic factors. Another cause of sarcoidosis may be infection, due to mycobacterial or other infections. Some drugs may be another cause of sarcoidosis.
   Is pollution or exposure to dust and particles another cause? There is an increased incidence of sarcoidosis or "sarcoid-like" granulomatous pulmonary disease among Fire Department of New York rescue workers since the World Trade Center disaster. On September 11, 2001, the attack and collapse of the World Trade Center in New York City released large amounts of airborne particulate matter and combustion byproducts.. Since then, an increased risk of granulomatous pneumonitis and cardiopulmonary sarcoidosis in workers exposed to dust have been reported.

Diet and sarcoidosis
In some cases sarcoidosis has been associated with celiac disease, such as a reaction to certain protein chains commonly referred to as glutens found in some cereal grains.

Sarcoidosis treatment
The is no overall medical consensus regarding the treatment of sarcoidosis. Corticosteroids remain the cornerstone of therapy, but immunosuppressive, cytotoxic, and immunomodulatory agents have emerged as potential treatment options for patients failing or experiencing side effects from corticosteroids. Methotrexate has been evaluated, and there have been studies with leflunomide, azathioprine, antimalarial and antimicrobial agents, and tumor necrosis factor-alpha inhibitors.
   Patients with sarcoidosis are at risk for osteoporosis caused by glucocorticoid therapy.

Outlook for a sarcoidosis patient
The progression of sarcoidosis varies among different patients, ranging from self-limited acute disease to a chronic debilitating disease that may result in death. Spontaneous remissions occur in about two thirds of patients, but 10-30% of patients have a more chronic or progressive course. Sarcoidosis often goes away on its own without treatment — usually within two to three years.

Sarcoidosis and depression
More than half of people with sarcoidosis have depression. Depression can affect one's work, school studies, sleep, and even appetite. Depression is treatable. Medications and/or talk therapy are often helpful.

Gastrointestinal sarcoidosis
Gastrointestinal  tract involvement in sarcoidosis is rare.

Cardiac sarcoidosis
Cardiac involvement is a rare and potentially life-threatening complication of sarcoidosis. Infliximab may be considered as an alternative first-line therapy in sarcoidosis with serious organ involvement.

Drug cause of sarcoidosis
Etanercept therapy may trigger sarcoidosis. Interferon could also be a drug induced cause.

Sarcoidosis emails
Q. Do you know how to treat neuro sarcoidosis?
   A. I am not familiar with neurosarcoidosis treatment.