Sarcoidosis

Sarcoidosis is a multi-system granulomatous disorder of unknown aetiology, characterised by the presence of non-caseating granulomas in affected tissues.

• Commonly affects adults aged 20-40.
• Higher prevalence in Afro-Caribbean populations.

• Immune response leads to non-caseating granulomas.
• Exact cause is unknown but likely involves genetic and environmental factors.

• Many are asymptomatic and discovered incidentally on imaging.
• Systemic: fever, fatigue, weight loss.
• Respiratory: dry cough, dyspnoea, chest pain.
• Eye: uveitis, conjunctivitis, blurred vision.
• Skin: erythema nodosum, lupus pernio, maculopapular rash.
• Musculoskeletal: arthralgia, arthritis.

• Imaging:
  • Chest X-ray: Bilateral hilar lymphadenopathy is classic.
  • HRCT: Nodularity, lymphadenopathy, lung fibrosis.
• Spirometry: restrictive lung pattern.
• Blood tests: raised serum ACE levels, hypercalcaemia.
• Biopsy of affected tissue: non-caseating granulomas.

• Observation: Many cases resolve spontaneously.
• Corticosteroids: First-line therapy for symptomatic sarcoidosis.
• Other immunosuppressants: Methotrexate, azathioprine if steroids contraindicated or for steroid-sparing effect.
• Treat specific organ manifestations (e.g., topical steroids for uveitis).

• Chronic respiratory failure.
• Pulmonary fibrosis.
• Cardiac arrhythmias or heart failure due to cardiac involvement.
• Visual impairment from ocular sarcoidosis.

• Variable, but often good with 2/3 of patients having spontaneous remission.
• Chronic disease can lead to fibrosis in affected organs.

• Sarcoidosis is a multi-system granulomatous disorder characterised by non-caseating granulomas.
• It is often discovered incidentally on imaging, where bilateral hilar lymphadenopathy is a classic sign.
• Where patients are symptomatic, these symptoms are systemic and corticosteroids are used first line.
• Prognosis is often good, with a majority of patients having spontaneous remission.