Sarcoidosis is a rare disease that has no known cure and results in wide-ranging negative consequences if unchecked. The disease impacts negatively on the victim's life by lowering his/her productivity. Additionally, sarcoidosis disease causes disabling symptoms on organs they attack, thereby resulting in unending pain to those affected by the disease. Other consequences include memory loss and cognitive impairment. It is therefore prudent to have a multidisciplinary personalized methodology that puts emphasis on psychosocial and somatic aspects of this disease. The disease can affect multiple organs of an individual, thereby subjecting the individual to an array of other pathological attacks and conditions such as cardiac arrest, congestive heart failure, and lung-rated diseases among others. Imperatively, one should not take the absence of physical manifestations in patients to be an evidence of absence of the disease. This paper gives a detailed description of sarcoidosis, its physical manifestations, statistical evidence, diagnosis, treatment options, projected patient outcomes, and other available interesting facts about the disease.
Sarcoidosis is a disease that is pathologically defined as the accumulation of mononuclear phagocytes and T-lymphocytes into the noncaseating granuloma's 'sine qua non' pathologic structure (Houston & Mukherjee, 2014). It results in the growth of tiny granulomas (inflammatory cells collections) in different body parts. The most affected body parts include the lungs, skin, lymph nodes, and the eye. The disease results when the immune system of the human body responds to strange substances that invade the immune system, usually substances inhaled from the atmosphere. In most cases, Sarcoidosis disappears on its own. However, on rare occasions, the disease stays for a long time, causing organ damage. It is important to note that there are many types of Sarcoidosis. Examples include annular, lupus pernio, ichthyosiform, erythrodermic, and hypopigmented sarcoidosis among others.
Signs and Symptoms of Sarcoidosis
Physical manifestations of this disease vary depending on the organ of the body that is affected. The disease is usually unpredictable in its development. It sometimes develops gradually but produces long-term symptoms while in other times; the symptoms of the disease appear and disappear quickly. It is interesting to note that most people suffering from sarcoidosis exhibit no symptoms, making the disease to be discovered only through an X-ray performed on the chest.
During the early stages of the disease, there are general symptoms that manifest themselves in sufferers of this disease. The general symptoms include fever, weight loss, fatigue, and swollen lymph nodes. According to Drent, Strookappe, Hoitsma, & De Vries (2015), with time, sufferers of this disorder may experience lung problems such as shortness of breath, chest pain, persistent dry cough, and wheezing. Other than lung problems, those suffering from Sarcoidosis may develop skin problems such as disfigured lesions, a rash of reddish-purple bumps, growth under the nodules, and lighter or darker areas in the skin. Sarcoidosis also affects the eyes but interestingly, they rarely cause eye symptoms. However, when the symptoms occur, they may encompass severe redness of the eye, blurred vision, sensitivity to light, and eye pain. Lastly, sufferers suffering from this disease exhibit cardiac symptoms and signs which include fatigue, dyspnea, arrhythmias, syncope, chest pain, edema, and palpitations. A research conducted by Houston and Mukherjee (2014) revealed the most prevalent clinical manifestations of sarcoidosis as summarized in table 1 below.
Table 1 showing most prevalent clinical manifestations of sarcoidosis
Clinical Manifestation Prevalence (%)
Sudden cardiac death 12-65
AV block 26-62
Supraventricular Tachycardia 0-15
Congestive Heart Failure 10-30
Ventricular Tachycardia 2-42
Bundle Branch Block 12-61
There are many existing research studies that have been carried out on sarcoidosis. For instance, a research by Kowalska, Niewiadomska, and Zejda (2014) was aimed at establishing the number of patients treated with sarcoidosis between 2006 and 2010. To achieve this, the researchers analyzed national Health Fund database in Katowice, Silesia. Information regarding date of birth, first illness, hospitalization, and the year of death were obtained. The patients were grouped into 4 different age groups of 19-34, 35-54, 55-64, and over 65 years. Crude incidence rates and prevalence in both women and men were then calculated per 100,000 persons. Kowalska et al. (2014) found out that the most common type of the disease is lung sarcoidosis which affected 966 out of 1217 patients diagnosed, representing 79.4%. Figure 1 below shows a summary of sarcoidosis incidence rates and prevalence.
Figure 1 showing a summary of sarcoidosis incidence rates and prevalence
The result of the research further indicated that sarcoidosis is most prevalent in adults between 35 and 54 years. Table 2 below shows a summary of the findings.
Table 2 showing prevalence of sarcoidosis in various age groups
Number and Percentage of Cases
Year Total population 19-34
(%) Average age
2006 192 28 49 17 6 43.713.0
2007 229 27 50 15 8 44.612.6
2008 253 33 47 17 4 42.412.2
2009 276 20 54 17 9 46.212.6
2010 267 30 41 23 6 44.913.0
In a similar study on sarcoidosis, Houston and Mukherjee (2014) did a research to establish annual incidences of the disease in the US. The researchers found out that the United States has a prevalence and incident rate of 35.5 cases per 100,000 in the African-American race and a lower prevalence rate of 10.9 per 10,000 for the white race. Women were found to be more susceptible to the disease than men. The highest prevalence rates were noted to be exhibited by women aged between 20 and 40 years. From the autopsy studies conducted, it was revealed that about 20-30% of all the sufferers of this disease possess pathologic cardiac involvement while 3-5% of the victims have clinically evident pathologic heart-related involvement.
Another empirical analysis conducted by Bowe, Jenssen, and Espinoza (2017) indicated that sarcoidosis prevalence varies between 1 and 40 cases per 100,000 persons depending on the culture and religion of people. Peak incidences of this disease were noted to occur in persons aged between 20 and 40 years. Bowe et al. (2017) also noted that African-Americans were 3 times susceptible to sarcoidosis than any other American race. Additionally, the research findings indicated that women were generally more likely to develop the disease than men. The trend remained validly differential when it was compared to various ethnic groups and cultures.
Diagnosis of Sarcoidosis
Imaging is a chief contributor to management and diagnosis of sarcoidosis. According to Spagnolo, Sverzellati, Wells, and Hansell (2014), the most common imaging modality is the computerized tomography (CT) which is vital in diverse clinical settings such as near-normal or normal chest radiograph, radiographic and/or atypical clinical findings, and complication detection. However, it is prudent to note that CT alone cannot result in an efficient diagnosis of sarcoidosis more so when it mimics other lung diseases. To ensure a proper diagnosis of sarcoidosis, histological confirmation is highly recommended. It is worthy to pinpoint that CT imaging modality provides critical prognostic information to a radiologist since it helps in discriminating between irreversible and reversible lung diseases. It is important to note that CT is not necessary for regular follow-up. For follow-up and assessment of lung involvement, Wessendorf, Bonella, and Costabel (2015) recommend pulmonary function tests. They further recommend bronchoscopy with biopsy for granulomas detection in peripheral lymph nodes or the skin. The researchers further assert that there is no isolated biomarker that is used in exclusion for correct sarcoidosis diagnosis. Instead, radiologists should combine more than one diagnosis method to realize a proper diagnosis of the disease.
Treatment Options Given to Sarcoidosis Patients
Treatment of sarcoidosis depends on two fundamental options: how to treat and whom to treat. Wijsenbeek and Culver (2015) explain that the treatment decision depends on the extent in which the organ is impaired, a threat to the functionality of the affected organ, the degree of symptoms of sarcoidosis on life quality, and the degree, chronicity, and the activity of the disease. While deciding on the best treatment for sarcoidosis patients, it is also worthy to consider the preferences and the input of the patients. The researchers discourage immunosuppressive medications on non-inflammatory manifestations of the disease. Lastly, the dosing, choices, and duration of both non-steroid and steroid medications require empirical adjustments depending on the individual patient. In their study, Drent et al. (2015) identified pharmacologic treatment such as glucocorticoids to be a cornerstone therapeutic agent for sarcoidosis in the short run. Other treatment options include the use of neurostimulants such as methylphenidate for the treatment of fatigue. Anticonvulsants and antidepressants are used to treat symptomatic neuropathic pain associated with sarcoidosis and help in relieving pain by 30-60%.
Projected Outcomes for Patients
There have been numerous research studies tailored towards estimating the course of sarcoidosis. However, the prognosis of this disease has remained difficult to estimate. According to empirical research conducted by Lynch III et al. (2014), 60% of sarcoidosis cases have granulomas disappearing within 2-5 years. After this period, patients recover and a relapse with patients experiencing remission is very unlikely. In other cases, the disease is progressive in some patients, leading to the affected organs to develop scars which necessitate ongoing treatment. Overall, sarcoidosis has a mortality rate of 5% but there are specific cases that warrant additional concerns. These cases involve scarring of lungs and the heart which may cause respiratory failure. There are ongoing research studies aimed at gathering substantial information about sarcoidosis and a specific estimate of mortality and morbidity in sarcoidosis patients. A similar study by Drent et al. (2015) revealed that natural history, clinical expression, and sarcoidosis prognosis vary and are often unpredictable. The researchers noted that remission occurs in at least 50% of sarcoidosis patients within 3 years after diagnosis and 66% in patients within 10 years from diagnostic date. Further, Drent et al. (2015) revealed that one-third of sarcoidosis patients are significantly affected by the disease, leading to organ impairment, which subsequently leads to a low quality of life.
Interesting Fact about Sarcoidosis
There are many types of sarcoidosis that affect different parts of the body and have various physical manifestations. Interestingly, cutaneous sarcoidosis has a wide spectrum of manifestation which makes it be popularly known as a Great Imitator (Tchernev et al., 2014).Despite the fact that there has been notable fundamental progress in diagnostic methods in the contemporary field of medicine, the pathogenesis mystery of cutaneous disease is appalling. It is prudent to note that usually, the production of epithelioid cell granuloma characterizea skin sarcoidosis. On the contrary, this can also be as a result of end reactions of infectious agents like coccidioidomycosis. Moreover, it can be due to mycobacterial antigens that are non-infectious during the set-up of diagnosis but immunogenic. It could be as well due to various tumor...
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