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Sarcoidosis

Background knowledge ๐Ÿง 

Definition

  • A multi-system granulomatous disorder of unknown aetiology, characterised by the presence of non-caseating granulomas in affected tissues

Epidemiology

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

Pathophysiology

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

Clinical Features ๐ŸŒก๏ธ

Symptoms

  • 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

Investigations ๐Ÿงช

Imaging

  • Chest X-ray: Bilateral hilar lymphadenopathy is classic
  • HRCT: Nodularity, lymphadenopathy, lung fibrosis

Other tests

  • Spirometry: restrictive lung pattern
  • Blood tests: raised serum ACE levels, hypercalcaemia
  • Biopsy of affected tissue: non-caseating granulomas

Management ๐Ÿฅผ

Management options

  • 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)

Prognosis

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

Complications

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

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